anzdata 36th annual report

AustraliaandNewZealandDialysisandTransplantRegistry

Thirsty Sixth Annual Report

2013

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ANZDATA Registry 2013 Report _____________________________________________________________________________________

Edited by

Philip Clayton Stephen McDonald

Kylie Hurst

Funded by Australian Organ and Tissue Authority

New Zealand Ministry of Health Kidney Health Australia

Supported by AMGEN Australia Pty Ltd

Novartis Pharmaceuticals Pty Ltd Pfizer Pty Ltd

Roche Products Pty Ltd Sanofi-Aventis Australia Pty Ltd

2013 Thirty Sixth

Annual Report

2013 Annual Report - 36th Edition

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Funding ANZDATA Registry is funded by

Australian Organ and Tissue Authority New Zealand Ministry of Health Kidney Health Australia Supported by Unrestricted Research Grants from AMGEN Australia Pty Ltd Novartis Pharmaceuticals Pty Ltd Pfizer Pty Ltd Roche Products Pty Ltd Sanofi-Aventis Australia Pty Ltd Coordinating Centre ANZDATA Registry 9th Floor - East Wing DX800 MP 117 Royal Adelaide Hospital North Terrace Adelaide, South Australia, 5000 Phone +61 8 8222 0949 Fax +61 8 8222 0985 Email [email protected] Web www.anzdata.org.au Prof G Russ Chair of ANZDATA Executive A/Prof S McDonald ANZDATA Executive Officer / Editor Dr P Clayton Amgen Fellow in Epidemiology / Editor Ms K Hurst Registry Manager / Editor Dr N Briggs Biostatistician Ms A Gulyani Biostatistician Ms H Dent Biostatistician Dr B Grace Research Fellow Ms M Kandamby Data Systems Manager Ms Lauren Bell Senior Project Officer Ms C Leitch Administration Ms B Martin Administration Ms M Steventon Administration Ms A Farmer Administration Ms J Adams Administration Printed in Adelaide, South Australia, 2014

© Copyright 2013 by the ANZDATA Registry

Acknowledgments ANZDATA Registry offers its most grateful appreciation to everyone who helped make this 36th Annual Report possible, especially the professionals and the staff of all the Renal Units and Tissue Typing Laboratories, upon whose reporting of data this enterprise ultimately depends. Suggested Citation

An example of suggested citation for this report is as follows:

.. [Author’s name] .. Peritoneal Dialysis .. [page numbers] .. ANZDATA Registry Report 2013 Australia and New Zealand Dialysis and Transplant Registry Adelaide, South Australia. Editors: Philip Clayton, Stephen McDonald, Kylie Hurst Publications based upon ANZDATA Registry information reported here or supplied upon request, must include the citation as noted above and the following notice:

The data reported here have been supplied by the Australia and New Zealand Dialysis and Transplant Registry. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the Australia and New Zealand Dialysis and Transplant Registry.

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The ANZDATA Registry has great pleasure in presenting the 2013 Annual Report. This is the 36th Annual Report from the Registry and covers data collected until the 31st December 2012. The Report is a result of the commitment and involvement of renal units throughout Australia and New Zealand. This commitment is a reflection of the enormous time and work from staff of these units. Participation of 100% of units in Australia and New Zealand continues and we are confident that all the patients who have received renal replacement therapy in Australia and New Zealand in this time period are included. This year’s Report includes some incremental improvements. The analyses of PD technique failure in chapter 5 have been substantially revised and now clearly demonstrate infection as the leading cause of technique failure. The kidney transplant waiting list data reported in chapter 7 now includes stock and flow by state and blood group, along with survival after wait-listing. Finally, chapter 10 (cancer) has been completely re-written. Further major changes to the Report are planned for next year. Similar to last year’s Report, the Appendices are provided as spreadsheets to facilitate analyses by end-users and are accessible from our website. Timely, accurate and complete data reporting is an ongoing challenge for the Registry and has presented a particular difficulty this year. Several items of the Survey now have a substantial proportion of missing data, and these are identified in the relevant figures. In particular, immunosuppression data were incompletely reported in 2012, and to avoid presenting a misleading picture these data have been withheld from chapter 8. We aim to complete collection of these data for inclusion in the next report. The Registry is currently modernising its database software. This is a large undertaking that we expect to be complete towards the end of 2014. The new database will allow web-based real-time entry of all data collected by the Registry. The role of Executive Officer of the Registry continues to be filled by Professor Stephen McDonald. Once again, he provides the intellectual and academic leadership of the Registry and has been the driving force in the dissemination of data and its analyses, both nationally and internationally.

Following completion of his time as the Epidemiology Fellow, Dr Philip Clayton has joined the Executive as Editor of the Annual Report. Professor Steven Chadban has also joined the Executive as the immediate past Chair of the ANZDATA Registry Steering Committee. Dr Namrata Khanal has joined the Registry as the new Epidemiology Fellow. We are greatly indebted to Amgen who continue to make the commitment through the funding of this position. For 11 years now this position has proven to be a major stimulus for the academic output of the Registry. Dr Blair Grace provided much analysis of the ANZDATA database throughout 2012-13; part of his salary support arose from a collaborative NHMRC funded project supervised by Professor McDonald. Mrs Kylie Hurst enters her third year as Manager of the ANZDATA Registry and we acknowledge the pivotal role that she has played in generating new ideas and innovations in the way the Registry functions. Christina Leitch continues to provide administrative support. Biostatistical expertise has been provided by Nancy Briggs, Hannah Dent and Aarti Gulyani. Professor Matthew Jose has taken over from Professor Chadban as the Chair of the ANZDATA Registry Steering Committee. His enthusiasm and ongoing interest in the Registry and its operations and output are acknowledged. The members of the ANZDATA Registry Committees and Working Groups are listed on page vii of this report. The Executive gratefully acknowledges the involvement and contribution of these many individuals. Major funding for the Registry has been provided from the Australian Commonwealth Department of Ageing through the Australian Organ and Tissue Donation and Transplant Authority, Kidney Health Australia and the New Zealand Ministry of Health. We also gratefully acknowledge industry support which in 2013 consisted of non-tied grants from AMGEN Australia, Novartis Pharmaceuticals, Pfizer, Roche Products and Sanofi-Aventis Australia. GRAEME R RUSS CHAIR ANZDATA EXECUTIVE July 2014

INTRODUCTION

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Page Contents iii

ANZDATA Committees v

Privacy vi

Guidelines for Data Release viii

Contributing Authors ix

Definitions and Methods x

Parent Hospitals, Transplanting Hospitals, Satellite Haemodialysis Units

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Publications 2012 xviii

Data Collection Form xxii

Summary xxvi

Chapter 1 Stock and Flow 1-1

Blair Grace, Kylie Hurst, Stephen McDonald, Philip Clayton

Chapter 2 New Patients 2-1

Blair Grace, Stephen McDonald, Kylie Hurst, Philip Clayton

Intake of Patients and Age of New Patients 2-2

State of Origin of New Patients 2-3

Incidence Rates New RRT by State 2-4

Incidence Rates New RRT by Age Group 2-5

Late Referral 2-6

Co-morbid Conditions 2-8

Primary Renal Disease of New Patients 2-10

Miscellaneous Causes of ESRD and Biopsy of New Patients

2-11

Chapter 3 Deaths 3-1

Stephen McDonald

Introduction 3-2

Death Rates During Renal Replacement Therapy 3-3

Survival by Age & Comorbidity 3-4

Dialysis Mortality Rates 3-5

Cause of Deaths 3-6

Withdrawal from Dialysis 3-8

Chapter 4 Method and Location of Dialysis 4-1

Nancy Briggs, Kylie Hurst, Stephen McDonald, Philip Clayton

Australia - Method and Location of Dialysis 4-2

New Zealand - Method and Location of Dialysis 4-4

Home RRT Modalities by Country 4-5

Home Dialysis Over Time 4-7

Chapter 5 Haemodialysis 5-1

Kevan Polkinghorne, Nancy Briggs, Namrata Khanal, Kylie Hurst, Philip Clayton

Stock and Flow 5-2

Blood Flow Rates 5-6

Duration of Dialysis 5-7

Outcomes Among Haemodialysis Patients 5-10

Membrane Type and Surface Areas 5-14

Anaemia 5-15

Haemoglobin 5-16

Ferritin and Transferrin Saturation 5-18

Serum Calcium 5-20

Serum Phosphate 5-21

Calcium-Phosphate 5-22

Urea Reduction Ratio 5-23

Vascular Access at First Treatment 5-25

Prevalent Haemodialysis Access 5-28

Obesity Among Incident Haemodialysis Patients 5-32

Obesity Among Prevalent Haemodialysis Patients 5-34

Home Haemodialysis 5-36

Technique Failure 5-39

Chapter 6 Peritoneal Dialysis 6-1

Neil Boudville, Hannah Dent, Stephen McDonald, Kylie Hurst, Philip Clayton

Stock and Flow 6-2

Peritoneal Dialysis Fluids 6-8

Outcomes Among Peritoneal Dialysis Patients 6-11

Peritoneal Dialysis Technique Survival 6-14

Technique Failure 6-16

Peritonitis 6-17

Page Chapter 6 Peritoneal Dialysis (contd.) 6-1

Australian Peritonitis Registry 6-20

Antibiotic Treatment 6-22

Outcomes 6-23

Haemoglobin 6-25

Ferritin and Transferrin Saturation 6-27

Serum Calcium 6-29

Serum Phosphate 6-30

Calcium-Phosphate 6-31

Chapter 7 Transplant Waiting List 7-1

Philip Clayton, Blair Grace, Jeremy Chapman, Jenni Wright, Stephen McDonald

Data from the National Organ Matching Scheme (Australia)

Chapter 8 Transplantation 8-1

Philip Clayton, Wai Lim, Kylie Hurst

Transplants Performed in 2012 8-2

Transplant Rate of Patients Dialysed 8-4

Age of Recipients Transplanted in 2012 8-5

Ethnicity of Transplant Recipients 8-6

Australian Regional Transplantation Activity 8-7

Functioning Transplants 8-8

Rates of Graft Loss 8-12

Immunosuppression 8-14

Use of Antibody Therapy 8-16

Rejection Rates 8-18

Primary Deceased Donor Survival 8-19

Deceased Second-Subsequent Survival 8-22

Primary Living Donor Survival 8-24

Living Second-Subsequent Survival 8-27

Chapter 9 Kidney Donation 9-1

Philip Clayton

Deceased Kidney Donors 9-2

Living Kidney Donors 9-4

Chapter 10 Cancer Report 10-1

Germaine Wong, Blair Grace, Philip Clayton, Jonathon C. Craig

Introduction and Cumulative Incidence of all Cancers 10.2

Frequency of Site-Specific Cancers 10.5

Novel Risk Factors for Cancer Development After Kidney Transplantation

10.6

Chapter 11 Paediatric Report 9-1

Sean Kennedy, Nancy Briggs, Hannah Dent, Stephen McDonald, Kylie Hurst, Philip Clayton,

Incidence and Prevalence 1991-2012 11-2

Causes of ESKD in Children and Adolescents 11-3

Modality of Treatment 11-4

Dialysis Delivery and Adequacy 11-4

Biochemical Outcomes 11-6

Vascular Access 11-7

PD Technique Survival by Age Category 11-8

Chapter 12 End-Stage Kidney Disease Among Indigenous Peoples of Australia and NZ

12-1

Stephen McDonald, Matthew Jose, Kylie Hurst

Introduction and New Patients 12-2

Incidence Rates 12-3

New Transplants 12-6

Prevalent Patients 12-8

Dialysis Modality 12-9

eGFR at Treatment Start 12-10

Incidence and Prevalence by State/Territory 12-11

Geographical Distribution 12-15

Late Referral and Vascular Access 12-18

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ANZDATA REGISTRY EXECUTIVE COMMITTEE Professor Steven Chadban - Chair A/Professor Stephen McDonald - Executive Officer Mrs Kylie Hurst - Registry Manager

ANZDATA REGISTRY STEERING COMMITTEE (2012 MEMBERS) Professor Steven Chadban (Chair) Professor Graeme Russ (Secretary / Chair ANZDATA Executive) Professor Stephen McDonald (Executive Officer) Ms Kylie Hurst (Executive Officer) A/Professor Timothy Mathew (Medical Director) Dr Grant Pidgeon (New Zealand Representative / Head of Renal Medicine) Dr Phillip Clayton (Fellow in Epidemiology) Dr Scott Campbell (Project Manager - Transplantation) Dr Matthew Jose (Project Manager - Indigenous Interest Group) A/Professor Kevan Polkinghorne (Project Manager - Haemodialysis) Dr Germaine Wong (Project Manager - Cancer Epidemiology) Dr Sean Kennedy (Paediatric Group) Dr Wai Lim Dr Helen Pilmore Dr Nicholas Gray A/Professor Robyn Langham Ms Cathy Hill (Nursing Representative)

Transplant Working Group A/Professor Scott Campbell (Project Manager) A/Professor Stephen McDonald Professor Graeme Russ Professor Steven Chadban Dr Wai Lim

Cancer Working Group Dr Angela Webster (Project Manager) Dr Germaine Wong (Fellow in Cancer Epidemiology) A/Professor Stephen McDonald Professor Jonathon Craig Professor Randall Faull Professor Adrian Hibberd Dr Rob Carroll

Peritoneal Dialysis Working Work Dr Neil Boudville (Project Manager) Professor David Johnson A/Professor Stephen McDonald A/Professor Kym Bannister Dr Sunil Badve Dr Philip Clayton Ms Monique Borlace

Paediatric Working Group Dr Steven McTaggart (Project Manager) A/Professor Stephen McDonald Dr Paul Henning Dr Lily Johnstone Dr Sean Kennedy

Haemodialysis Working Group A/Professor Kevan Polkinghorne (Project Manager) A/Professor Stephen McDonald A/Prof Rowan Walker Professor Richard Allan Dr Mark Marshall Dr Vincent Lee

Indigenous Interest Group Dr Matthew Jose (Project Manager) A/Professor Stephen McDonald A/Professor Johan Rosman A/Professor Mark Thomas Professor John Collins Dr Karen Barraclough Dr Greg Perry Dr Natasha Rogers Dr Jacqueline Hughes Dr Paul Lawton Ms Lesley Salem

ANZDATA REGISTRY WORKING GROUPS (2012 MEMBERSHIP)

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PRIVACY ASPECTS OF DATA COLLECTION

In December 2001 changes to the Commonwealth Privacy Act were introduced which have led to changes to the collection of personal information. Essentially these extend to the private sector a number of changes based around 10 “National Privacy Principles” (NPP’s). A detailed exposition of these can be found at the Privacy Commissioner’s website (www.privacy.gov.au). Briefly, however, health information is treated as “sensitive” information, which must usually be collected and handled with consent of the person, unless certain conditions are met. Patients are entitled to view the information the Registry holds about them, and request alterations if the data is thought to be inaccurate.

Each Australian State has also enacted similar provisions which cover practice and patients in public hospitals.

ANZDATA does not release data identifiable by patient name. Results are published/released in tabular or graphic format only. Requests for data are met using deindentified data only. On occasion, when data identifying particular hospitals is involved, consent from the Director of the relevent renal unit is sought prior to the release of information.

ANZDATA spent some time during 2002 formulating an appropriate response to these issues including seeking advice from a variety of sources. The approach taken has been that of a “opt-out” consent, whereby patients are distributed information outlining the nature and purpose of the information collected, offered an opportunity to view that data and ask questions, and the opportunity to request withdrawal of part or all of their data. This approach is explicitly suggested for Registries by the Privacy Commissioner in his “Guidelines for the Health Sector”. To this end ANZDATA has circulated to all participating hospitals a patient information sheet (see opposite), for each hospital to use (or a locally modified version if appropriate) to inform patients.

At the time of data collection each unit is asked to certify that they have complied with measures under the relevant privacy measures.

Tissue Typing Data and Transplant Waiting List data are collected in each Tissue Typing Laboratory and entered into the National Organ Matching System database. These data are transmitted to ANZDATA for inclusion in the ANZDATA database and for this Report.

PRIVACY

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ANZDATA REGISTRY AUSTRALIA AND NEW ZEALAND DIALYSIS AND TRANSPLANT REGISTRY

C/- Royal Adelaide Hospital Phone: (08) 8222.0949 North Terrace, Fax: (08) 8222.0985 Adelaide, 5000 Email: [email protected] South Australia Web: http://www.anzdata.org.au

Important Privacy Information As part of routine medical care of people receiving treatment with dialysis or kidney transplantation, your kidney specialist collects certain information about the patients they treat. All kidney specialists throughout Australia and New Zealand report this information every twelve months to the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). ANZDATA collects the information for the purpose of monitoring treatments and performing analyses to improve quality of care for people with kidney failure.

1. What is ANZDATA ?

ANZDATA is an organization set up by Kidney Health Australia and the Australia and New Zealand Society of Nephrology to monitor dialysis and transplant treatments. ANZDATA is funded by the Australian and New Zealand Governments and Kidney Health Australia.

2. What information is collected about you ?

This information includes your name, age, gender, racial origin, hospital of treatment, some aspects of your medical condition (such as whether you have diabetes) and details about the type of kidney treatment you are receiving (dialysis or transplant).

We DO NOT collect details about your address, telephone number, medical insurance, or non-medical matters such as occupation, income, etc.

3. Is personal data ever released ?

The identity of people in the database IS NOT released publicly nor in any reports. Measures have been put into place to ensure the security of all collected information.

4. What is this information used for ?

The information is used primarily for quality assurance, investigating patterns of kidney disease, and planning appropriate health services. We release reports on a variety of topics, including an Annual Report examining the rates and treatment of kidney failure in Australia and New Zealand. We also have a major role in ensuring the quality of patient care by sending to each kidney unit each year a report outlining their activity. These reports also compare the outcome of the treatment they provide with that of other units throughout the two countries.

Reports are also produced at a state and national level, and from time to time analyses are also produced for renal units, government health departments and industry concentrating on particular aspects of renal failure management e.g. peritoneal dialysis, transplantation, haemodialysis.

5. Can you see what personal information ANZDATA collects and the reports that it produces ?

Individuals are able to view their own information on request. You can request alterations if you believe it is inaccurate. You may also opt not to have your treatment included in this database, and you should let your kidney specialist know if this is the case. You can also choose not to have some information (eg racial origin)recorded. However, if your information is not included in the Registry, the ability to compare results in Australia and New Zealand or to analyse the results of different treatment methods and for different patient types (eg diabetics) will be compromised.

The national reports and much other material produced by ANZDATA are available free on the Internet at www.anzdata.org.au, or they can be sent to you on request to the address above. Your kidney specialist will also have copies of many of the reports.

If you wish to discuss any of the issues raised here, please let your doctor know or telephone the ANZDATA

Registry direct on [08] 8222 0949. You may also write to us (ANZDATA Registry, C/- Royal Adelaide Hospital, DX800, Mail Point 117, North Terrace, Adelaide, SA. 5000) or send us an e-mail ([email protected]).

PRIVACY

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GUIDELINES FOR DATA RELEASE

The policy for release of data to investigators, renal units and others was revised during 2013 and is summarised on the Website. ANZDATA encourages the analysis, use and citation of its data, and receives many data requests annually which vary in size and complexity. At times these overwhelm the limited resources within the Registry, and must be prioritised. Generally, formal requests for data are preceded by a period of consultation with a member of the Registry staff. Requests are welcome from Renal Physicians, other staff members of Renal Units, Charitable Bodies, Academic Institutions, Government Departments and Industry. Requests dealing with identifiable Hospital data (i.e. data which identifies outcomes of an individual hospital) will only be fulfilled with the explicit consent of the Heads of the relevant Hospital Units. Individual patient identified data (names) is not released.

ATTRIBUTION OF PUBLICATIONS

The policy on attribution of publications which incorporate ANZDATA sourced data was revised during 2002, following a period of consultation with participating physicians.

Where a member of a participating unit has analysed data provided by ANZDATA and subsequently prepared a manuscript, then “ANZDATA Registry” should be acknowledged as a secondary institution in addition to the author’s Hospital or University. This applies whether the primary data analysis is performed by the author or by ANZDATA staff. Where the author is an ANZDATA office holder or staff member then the primary attribution should be “ANZDATA Registry”.

Where ANZDATA data is only a minor portion of the work, then it may be more appropriate to acknowledge the source explicitly in the “Acknowledgements” section.

In both cases the disclaimer on page ii of this report should be included.

In all cases the source and treatment of the data should be made clear in the “Methods” section. Preferably the abstract (and keywords if applicable) should also include “ANZDATA” which would allow for searching Registry publications.

POLICY

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Dr Neil Boudville Head of Department Renal Medicine Sir Charles Gardiner Hospital, Hospital Avenue Nedlands, Western Australia, 6009 Dr Nancy Briggs Biostatistician ANZDATA Registry Royal Adelaide Hospital, North Terrace Adelaide, South Australia, 5000 Professor Steven Chadban Chair - ANZDATA Registry Nephrologist and Transplant Physician Royal Prince Alfred Hospital, Missenden Road Camperdown, New South Wales, 2000 Professor Jeremy Chapman OAM Director of Medicine & Cancer Services Westmead Hospital Cnr Hawkesbury Road & Darcy Road Westmead, New South Wales, 2145 NOMS Chairman Dr Philip Clayton Epidemiologist / ANZDATA Registry Royal Adelaide Hospital, North Terrace Adelaide, South Australia, 5000 Dr Blair Grace ANZDATA Registry / Research Fellow Royal Adelaide Hospital, North Terrace Adelaide, South Australia, 5000 Mrs Aarti Gulyani Biostatistician ANZDATA Registry Royal Adelaide Hospital, North Terrace Adelaide, South Australia, 5000 Mrs Hannah Dent Biostatistician ANZDATA Registry Royal Adelaide Hospital, North Terrace Adelaide, South Australia, 5000 Mrs Kylie Hurst ANZDATA Registry Manager Royal Adelaide Hospital, North Terrace Adelaide, South Australia, 5000 Dr Matthew Jose Nephrologist Department of Nephrology Royal Hobart Hospital Hobart, Tasmania, 7000 Dr Sean Kennedy Paediatric Nephrologist Nephrology Department Sydney Children’s Hospital Randwick, NSW, 2031

CONTRIBUTING AUTHORS

Dr Namrata Khanal Epidemiology Fellow ANZDATA Registry Royal Adelaide Hospital, North Terrace Adelaide, South Australia, 5000 Dr Wai Lim Nephrologist Sir Charles Gardiner Hospital, Hospital Avenue Nedlands, Western Australia, 6009 Associate Professor Stephen McDonald Executive Officer, ANZDATA Nephrologist Royal Adelaide Hospital, North Terrace Adelaide, South Australia, 5000 Dr Steven McTaggart Paediatric Nephrologist Queensland Child and Adolescent Renal service Mater Children’s Hospital Raymond Terrace South Brisbane, Qld 4101 Associate Professor Kevan Polkinghorne Nephrologist Department of Nephrology Monash Medical Centre Clayton Road, Clayton, Victoria, 3168

Professor Graeme Russ Chair ANZDATA Executive Co-Director Renal Unit Royal Adelaide Hospital, North Terrace Adelaide, South Australia, 5000 Dr Germaine Wong Fellow in Cancer Epidemiology ANZDATA Registry Royal Adelaide Hospital, North Terrace Adelaide, South Australia, 5000 Jenni Wright Senior Analyst Transplant Systems Australian Red Cross Blood Service 70 O’Riordan Street Alexandria, New South Wales, 2015

CONTRIBUTING AUTHORS

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A number of definitions given below are used throughout this report unless otherwise stated. 1. Wording Throughout this report ‘treatment’ refers to renal replacement therapy, including haemodialysis, peritoneal dialysis and transplantation. In places the word “graft” (or “allograft”) is used for kidney transplant.

HD = haemodialysis CAPD = continuous ambulatory peritoneal dialysis APD = automated peritoneal dialysis ESKD = end stage kidney disease 2. Data collection ANZDATA collects information from all renal units in Australia and New Zealand. Data collection occurs at two time points. Key events (new patients, deaths, transplants) are notified as they occur, with units requested to send this at least monthly. This can occur either via a web-based interface or paper submission. An extensive cross-sectional survey is then performed twelve monthly (for data to 31st December). Currently this is by a paper-based system, with manual completion of the form and manual data entry. No formal audit mechanism is in place at this stage.

For kidney transplants, HLA matching and panel reactive antibodies are obtained direct from the National Organ Matching System.

Monthly summaries are distributed to the contributing units. Results contained in this (and other reports) are based on a final database locked and prepared after the end of year survey returns are received. 3. Inclusion criteria Included in the Registry are all patients resident in Australia or New Zealand receiving renal replacement therapy where the intention to treat is long-term, ie medical opinion is that renal function will not recover. Cases of acute renal failure are excluded. People who move overseas permanently are censored at date of last treatment (or departure in the case of transplant recipients). 4. Modality attribution For survival analysis the initial mode of dialysis is generally determined at 90 days after first treatment, to allow for early changes and maturation of access. Other transfers (between modalities, or from satellite to hospital haemodialysis etc.) are not analysed if less than 30 days, except for transfers between dialysis centres to which a 60 day rule is applied to allow for holiday movements. 5. Underlying renal disease This is recorded by the treating hospital according to a modified EDTA coding system (details on back of survey form).

6. Deaths Death rate is predominantly reported as number of patients died/total number of years of treatment of all patients treated at any time during the year. It is expressed as deaths per 100 patient years (pt yrs) at risk.

7. Comorbid conditions These are recorded by the treating hospital. No formal definitions are supplied; the treating clinician is asked to record whether the patient has coronary artery disease, chronic lung disease, cerebrovascular disease, peripheral vascular disease or diabetes according to their clinical opinion on a yes / suspected / no basis.

8. Transplant Waiting List The active transplant waiting list is based on data from the National Organ Matching System (Australia) cross-checked with ANZDATA.

9. Derived measures

9.1 Haemoglobin Haemoglobin is recorded as the last available measurement before the end of the survey period.

9.2 Erythropoietic agents Erythropoietin agent use is recorded as “yes” if these agents were used at any time during the survey period.

9.3 Iron studies Iron studies are requested within the last three months of the survey period.

9.4 Estimated creatinine clearance Where creatinine clearance is estimated from serum creatinine at entry or post transplantation, the 4-variable MDRD formula is used [1]

eGFR = 186 x Cr^-1.154 x age^-0.203 x 1.212 if black x 0.742 if female (where Cr is creatinine in mg/dL and age is age in years)

The weight term used for this is lean body mass, calculated using the equation LBW=(0.9*[height-152])+(50 if male, 45.5 if female) [2]

9.5 Urea reduction ratio / Kt/V Results are requested in one of these formats, using the stop flow method on a mid-week dialysis. Single pool Kt/V is collected, along with the method used. For conversion of URR to Kt/V urea the formula used [3] is

Kt/V = 0.023*PRU - 0.284 (note that PRU = percent reduction in urea and not URR).

DEFINITIONS AND METHODS

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9.6 Body mass index Body mass index (BMI) is calculated as weight (kg) (height (m))2

The categories used are : underweight <20 kg/m2 , normal 20-24.9 kg/m2, overweight 25-29.9 kg/m2, obese >=30 kg/m2 9.7 Peritoneal dialysis measures These are the standard measures, often calculated by computerised patient management programs.

9.7.1 Residual renal function The measure used is the arithmetic mean of urea and creatinine clearance from a 24-hour urine collection and serum creatinine and urea.

9.7.2 Peritoneal equilibration test The ratio of dialysate to plasma glucose is used, following a 4 hour dwell of a 2 litre 2.5% bag of dialysate, performed within 6 months after initiation of peritoneal dialysis.

10. Rates and Measures

10.1 Incidence rates Except where otherwise stated, quoted incidence rates are per calendar year, and are expressed per million population.

10.2 Prevalence rates Except where otherwise specified, prevalence rates are point prevalence rates at 31st December 2011.

10.3 Population denominator

All populations used in this report were stratified by age and sex.

Australian populations were taken from the Australian Bureau of Statistics (ABS).

All populations used were for 30 June of each year, except for total New Zealand populations, where data for 31 December were readily available, and all websites were accessed 20th September 2012.

Population data for each Australian state and territory came from ABS 3101.0 series (4)

Population data for Indigenous Australians were taken from ABS 3238.0(5), using series A (the most conservative estimates) for populations after 2006.

Populations serviced by the Greater Southern Area Health Service were estimated by the South Eastern Region of NSW. These estimates were taken from ABS 3235.0(6)

All New Zealand population estimates were taken from Statistics New Zealand (SNZ). Total populations were taken from NZ Infoshare (7) and Maori populations were taken from NZ Infoshare Maori population estimates (8).

Estimates of resident Pacific People populations after were taken from (9) for years 2006 onwards. Prior to this, populations of Pacific people before 2006 were only available for years 1996, 2001 (and 2006), and we used linear interpolation to estimate populations for each age and sex group for the years 1997-2001 and 2002-2005.

10.4 Survival rates For transplant recipients, survival rates exclude those who were transplanted overseas or were recipients of multiple organ grafts.

Graft survival (unless otherwise qualified) includes both cessation of graft function (ie return to dialysis) and patient death.

Rates for patient survival for fixed periods for transplantation are calculated according to the life-table method and thus include an adjustment to the risk-set of ½ of those censored without failure over the interval to create an “average” risk set.

10.5 Graft survival For outcomes of kidney transplants, graft failure includes both loss of graft function (ie return to dialysis) and death of patients (with graft function). Calculations of patient survival for transplant recipients includes all subsequent modalities (i.e. deaths after graft failure are included). Patients transplanted overseas are excluded from calculations.

10.6 Dialysis Survival Patient and technique survivals for haemodialysis and peritoneal dialysis are based on the dialysis modality at 90 days after first treatment for patients not transplanted during that period. Patients are followed up until they are either transplanted (at which point they are censored) or until they have a ‘permanent’ change of dialysis modality or until death or most recent follow up date. A ‘permanent’ change of dialysis is defined as any change in excess of 30 days.

Peritonitis survivals are calculated from first peritoneal dialysis (ignoring all earlier treatments) to date of first peritonitis episode. If there were no episodes of peritonitis then calculation is censored at change of treatment from peritoneal dialysis to haemodialysis or transplantation. Peritoneal dialysis includes automated peritoneal and continous ambulatory peritoneal dialysis. Excluded are patients who had peritonitis before commencing peritoneal dialysis.

10.8 Death and other event rates Rates are expressed per 100 person years at risk (unless otherwise stated). Some analyses include survival of all patients,

others exclude the first 90 days of followup. This is stated in the individual analyses.

10.9 Age standardisation All rates are crude, not age-standardised. The age distribution of the populations for Australia and New Zealand


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Can be obtained by contacting the Registry.

10.10 Peritonitis rates Peritonitis rates are present using episodes of peritonitis reported during periods of peritoneal dialysis - episodes reported prior to commencement of peritoneal dialysis (for example between Tenckhoff catheter insertion and commencement of peritoneal dialysis) are not included in these calculations.

11. Database Data is stored on a relational database using Oracle version 9I.

12. Statistics Statistical analyses were performed using Stata version 12.

13. References

1) Levey A, Greene T, Kusek J, Beck G. A simplified equation to predict glomerular filtration rate from serum creatinine (abstract). J Am Soc Nephrol. 2000 May 20;11(11):155A.

2) Zasadny KR, Wahl RL: Standardized uptake values of normal tissues at PET with 2-[fluorine-18]-fluoro-2-deoxy-D-glucose: variation with body weight and method for correction. Radiology 1993: 189;847-850.

3) Basile C, Casino F, Lopez T: Percent reduction in blood urea concentration during dialysis estimates Kt/V in a simple and accurate way. Am J Kidney Dis 1990: 15;40-45.

4) http://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/3101.0Jun%202011?OpenDocument

5) http://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/3238.01991%20to%202021?OpenDocument

6) http://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/3235.02011?OpenDocument

7) http://www.stats.govt.nz/infoshare/SelectVariables.aspx?pxID=59949f0f-e948-429b-8ed7-7d702c1b39c0

8) http://www.stats.govt.nz/~/media/Statistics/browse-categories/population/estimates-projections/national-pop-estimates/Maori-population-estimates-30-June-19912011.xls

9) http://nzdotstat.stats.govt.nz/wbos/Index.aspx?DataSetCode=TABLECODE31


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HOSPITALS

Parent hospitals, transplanting unit and satellite dialysis units together with their state and unit codes are listed below. In some cases, these have combined as part of a regional network and this is also indicated. The definition of a ‘parent hos-pital’ is a pragmatic one, and refers to units which offer a full range of dialysis services (i.e. can commence patients on dialysis, have on-site nephrologist presence and can deal with patients of all degrees of complexity).

In contrast, satellite units provide haemodialysis treatments to selected patients, usually with lower staff ratios and no on-site nephrologist.

NOTE: The states listed below are in no particular order.

QUEENSLAND (STATE CODE 4)

PARENT HOSPITALS Unit Code

Allamanda Private Hospital (Fresenius) ALLA

Bundaberg Base Hospital BUND Cairns Base Hospital CAIR Chermside Dialysis Unit (Fresenius) CHER Child and Adolescent Renal Service CARS Gold Coast Hospital GOLD Greenslopes Private Hospital (Baxter) GREN Hervey Bay Hospital HERV John Flynn Hospital FLYN Mackay Base Hospital MACK Princess Alexandra Hospital PSAH Queensland Renal Transplant Service QRTS Rockhampton Base Hospital ROCK Royal Brisbane Hospital RBSH St Andrew’s Dialysis Clinic (Diaverum) GSTA Sunshine Coast Health District Caloundra Private Hospital CALO Nambour General Hospital NAMB

Nambour Selangor Private Hospital NPRV

The Townsville Hospital TOWN Toowoomba Hospital TWMB Wesley Private Hospital WSLY

TRANSPLANTING UNIT Unit Code

Queensland Renal Transplantation Service QRTS

Princess Alexandra Hospital (Adult and Paediatric) Director of Transplantation

Dr Tony Griffin Ipswich Road Woolloongabba 4102

SATELLITE DIALYSIS UNITS Unit Code Atherton Private Hospital ATHR

Cairns Home Training Unit CHTR

Cairns Private Hospital Satellite CPRV

Caloundra Public Hospital CAPU

Cooktown Satellite COOK

East Street Self Care Dialysis Unit EAST

Gympie Satellite GYMP

Home Hill Satellite HILL

Innisfail Hospital INNI

Ipswich Satellite IPSW

Kingaroy Satellite KROY

Logan Satellite LOGN

Maryborough Hospital MARY

Mossman Satellite MOSS

Mt. Isa Satellite MTIS

Noosa Satellite NOOS

North Lakes Dialysis Unit NLAK

North Ward Satellite NWAR

Palm Island Satellite PISL

Redcliffe Satellite REDC

Redlands Satellite REDL

St Vincent’s Robina Satellite STVR

AUSTRALIAN CAPITAL TERRITORY (ACT) (STATE CODE 9)


The Canberra Hospital CANB

SATELLITE DIALYSIS UNITS Unit Code

Canberra Community Satellite CSAT

Northside Dialysis Clinic (Fresenius) NSID

TASMANIA (STATE CODE 7)


Launceston General Hospital LAUN

Royal Hobart Hospital RHBT


Launceston Community Centre Satellite LCCS

North West Renal Unit, Burnie NWRU

xiii


SOUTH AUSTRALIA (STATE CODE 5)


Flinders Medical Centre FMDC

Central Northern Adelaide Transplant Service CNAR

The Queen Elizabeth Hospital QEZB

Royal Adelaide Hospital RADL

Women’s and Children’s Hospital WCHL

TRANSPLANTING UNIT Unit Code Central Northern Adelaide Transplant Service CNAR Royal Adelaide Hospital Director - Professor Graeme Russ North Terrace Adelaide 5000

Women’s and Children’s Hospital WCHL Director - Dr Paul Henning 72 King William Road North Adelaide 5006

SATELLITE DIALYSIS UNITS Unit Code Berri Satellite BERI Ceduna Hospital CEDU Clare Satellite CLAR Hampstead Rehabilitation Satellite HAMP Hartley Private Hospital (Fresenius) HART Port Lincoln Satellite Centre LINC

Lyell McEwin Satellite LMCK

Millicent Hospital MILL Maitland Hospital MLAN Modbury Satellite (Fresenius) MSAT Mount Gambier Satellite MTGA Murray Bridge Hospital MURR Noarlunga Satellite NOAR Payneham Satellite (Baxter) PAYN Port Augusta Hospital PTAG Port Piri Satellite PIRI Victor Harbour Satellite VHAR Wayville Satellite Centre WAYV Whyalla Satellite Centre WHYA

NORTHERN TERRITORY (STATE CODE 1)


Alice Springs Hospital ALIC

Royal Darwin Hospital DARW

SATELLITE DIALYSIS UNITS Unit Code Flynn Drive Satellite FDVE

Katherine Dialysis Unit KATH Nightcliff Community Centre NTCL Palmerston Satellite PTON Tennant Creek Hospital TENN Tiwi Dialysis Centre TIWI

WESTERN AUSTRALIA (STATE CODE 6)


Fremantle Hospital FREM

Princess Margaret Hospital for Children PMHC

Royal Perth Hospital RLPT

Sir Charles Gairdner Hospital SCGH

TRANSPLANTING UNIT Unit Code Princess Margaret Hospital for Children PMHC Director - Dr Ian Hewitt Roberts Road Subiaco 6008

Royal Perth Hospital RLPT Director - Dr Kevin Warr Wellington Street Perth 6001

Sir Charles Gairdner Hospital SCGH Director - Dr Harry Moody Verdun Street Nedlands 6009

SATELLITE DIALYSIS UNITS Unit Code Albany ALBA Armadale Satellite ARMA Bunbury Satellite BUNB Busselton Satellite BUSS Cannington Dialysis Clinic (Diaverum) CANN Derby Satellite DERB Geraldton Hospital GRLD Joondalup Satellite JOON Hollywood Private Hospital HPRH Kalgoorlie Dialysis Unit KALG Kimberley Dialysis Centre KIMB Melville Satellite MELV Midland Private Dialysis Centre (Baxter) MIDL Murdoch STJM Peel Health Campus MAND Port Hedland Dialysis Unit (Pilbara) PTHD Rockingham Satellite RHAM Spearwood Satellite SPEA Stirling Dialysis Clinic (Diaverum) STIR

St. John of God Private Hospital

Subiaco SJOG

HOSPITALS

xiv


PARENT HOSPITALS Unit Code Alfred Hospital ALFD

Austin Health AUST Bendigo Hospital BEND

Eastern Health Integrated Renal Services EHRS

Epworth Hospital EPWT Forest Hill Dialysis Centre (Fresenius) FORE Geelong Hospital GLNG Kew Private Dialysis Centre KEWP Malvern Dialysis Centre (Fresenius) MALV Monash Medical Centre – Adult MMCA Monash Medical Centre – Paediatric MMCP

North West Dialysis Service NWDS Royal Melbourne Hospital RMBH Royal Children’s Hospital RCHL St. Vincent’s Hospital SVIN Western Health WSTH

Diamond Valley Dialysis Clinic (Diaverum) GDIA

North Melbourne Dialysis Clinic (Diaverum) NMDC


Alfred Hospital ALFD

Director - Professor Napier Thomson Commercial Road Prahran 3181

Austin Health AUST Director - Dr David Power Burgundy Road Heidelberg 3084

Monash Medical Centre (Paediatric) MMCP Director - Dr Amanda Walker 246 Clayton Road Clayton 3165

Monash Medical Centre (Adult) MMCA Director - Professor Peter Kerr 246 Clayton Road Clayton 3165

Royal Children’s Hospital RCHL Director - Dr Colin Jones Flemington Road Parkville 3052 Royal Melbourne Hospital RMBH Director - Professor Gavin Becker Parkville 3052

St. Vincent’s Hospital SVIN Director - Professor Robyn Langham 41 Victoria Parade Fitzroy 3065


Coburg Satellite COBG Cohuna Hospital COHU Colac Hospital COLA Corryong Satellite CORR Craigieburn Satellite CRAI Cranbourne Satellite CRAN Dandenong Satellite DAND Daylesford Hospital DAYL Donald Hospital DONA Eastern Health Incentre Dialysis EHUB Echuca Hospital ECHU Edenhope Hospital EDEN Epping Dialysis Unit EPPG Frankston Satellite FRAN Goulburn Valley Hospital GVAL Hamilton Hospital HAML Hastings Hospital HSTG Heidelberg Hospital HEDG Horsham Satellite HORS Kyabram Satellite KYAB Kyneton Hospital KYNE Latrobe Regional Satellite LATR Mansfield District Hospital MANS Maroondah Satellite MARO Maryborough Hospital MRYB Melton Hospital MELT Mildura Hospital MILD Moorabbin Satellite MOOR Myrtleford Hospital MYRT Newcomb Satellite NCOM Nhill Hospital Satellite NHIL Northern Hospital Satellite NSAT North East Kidney Service NEKS Orbost Hospital ORBO Peter James Centre PJAM Portland District Health PORT Robinvale Hospital ROBV Rosebud Hospital ROSE Sale Hospital SALE Sandringham Satellite SNDR Seymour Hospital SEYM South Geelong Satellite SGEO St. George’s Hospital SGRU Sunbury Satellite SUNB Sunshine Satellite Centre SUNS Swan Hill Hospital SWAN Terang Hospital TERA Wagga Hospital WAGG Wangaratta Hospital WANG Warnnambool Hospital WARN Werribee Mercy Hospital WERR Western Gippsland Hospital WGIP Williamstown Satellite WILL Wodonga Regional Health Service WDGA Wonthaggi Hospital WONT Yarawonga District Hospital YARA Yarram Hospital YARM

Caulfield General Medical Centre CAUL Casterton Hospital CAST

VICTORIA (STATE CODE 3)

SATELLITE DIALYSIS UNITS Unit Code Broadmeadows Satellite BRDM Brunswick Satellite BRUN Casey Hospital CASE

HOSPITALS

xv



John Hunter Hospital HUNT

Director of Transplantation -

Professor Adrian Hibberd

Lookout Road

New Lambton Heights

Newcastle 2304

Prince of Wales Hospital POWH

Director - Professor Bruce Pussell

Barker Street

Randwick 2031

Royal North Shore Hospital RNSH

Director - Dr Bruce Cooper

Pacific Highway

St Leonards 2065

Statewide Renal Services SWRS

Royal Prince Alfred Hospital RPAH

Director of Transplantation - Professor Steven Chadban

Missenden Road

Camperdown 2050

NEW SOUTH WALES (STATE CODE 2)


Armidale Hospital ARMD

Auburn Satellite AUBN

Ballina Hospital BLNA

Bankstown Hospital BANK

Bathurst Satellite Dialysis Centre BATH

Bega Satellite BEGA

Blacktown Regional Dialysis BLAK

Bondi Dialysis Unit (Diaverum) BOND

Brewarrina Hospital BREW

Broken Hill Hospital BROK

Campbelltown Satellite CAMP

Concord Repatriation Satellite Unit CRSU

Condobolin Hospital COND

Coonamble Hospital COON

Dame Eadith Walker DEWE

Eora Satellite EORA

Fairfield Satellite FAIR

Forbes Hospital FORB

Gilgandra Satellite GILG

Gosford Satellite GOSS

Goulburn Satellite (Fresenius) GLBN

Grafton Hospital GRFT

Griffith Base Hospital GRIF

Invarell Satellite INVR

Lakehaven Satellite LAKE

Lanceley Cottage LANC

Liverpool Community Centre LCOM

Maitland Hospital MAIT

Mona Vale Satellite MNVL

Moree Satellite MORE

Moruya Satellite (Fresenius) MORU

Muswellbrook MUSW

Concord Hospital CONC

PARENT HOSPITALS Unit Code Dubbo Base Hospital DUBB East Coast Renal Service Prince of Wales Hospital POWH St. George Hospital STGH St. Vincent’s Hospital STVI Sydney Children’s Hospital SCHL Wollongong Hospital WGNG Gosford Hospital GOSF John Hunter Hospital HUNT Lindfield Dialysis Unit (Diaverum) LIND Lismore Hospital LISM Lismore Private Dialysis Clinic LPDC Macleay Dialysis Centre - Kempsey MACL Manning Rural Referral Hospital MANN Mater Misericordiae Hospital MATR Mayo Private - Taree MAYO Newcastle Nephrocare NCAS Port Macquarie Base Hospital PTMQ Port Macquarie Private Hospital PMPH Royal North Shore Hospital RNSH South West Sydney Renal Services SSYD Liverpool Hospital LVPL Statewide Renal Services SWRS Royal Prince Alfred Hospital RPAH Sydney Adventist Hospital SADV Tamworth Hospital TAMW The Children’s Hospital at Westmead NEWC The Tweed Hospital TWHD Western Renal Network Nepean Hospital NEPN Orange Hospital ORAN

Westmead Hospital WEST

Sydney Children’s Hospital SCHL

Director - Dr Andrew Rosenberg

C/- Department of Nephrology

Prince of Wales Hospital

Barker Street

Randwick 2031

The Children’s Hospital at Westmead NEWC

Director - Dr Stephen Alexander

Cnr Hawkesbury and Hainsworth Street

Westmead 2145

Westmead Hospital WEST

Director - Professor Jeremy Chapman

Cnr Hawkesbury and Darcy Road

Westmead 2145

TRANSPLANTING UNIT (CONT) Unit Code

HOSPITALS

xvi


Norfolk Island Hospital NORF

Penrith Community Dialysis Centre PCDC

Shellharbour SHEL

Shoalhaven Satellite (Nowra) SHOA

Singleton Satellite SING

Sutherland Hospital SUTH

Sydney Dialysis Centre SYDC

Taree Community Dialysis NITA

Wagga Wagga Base Hospital WAGG

Wansey Satellite WANS

Wellington Hospital WGTN

Wollongong Satellite WSAT


NEW SOUTH WALES (CONT)

NEW ZEALAND (CODE 8)


Auckland City Hospital AUCK

Starship Children’s Hospital STAR

Christchurch Hospital CHCH

Dunedin Hospital DUND

Hawkes Bay Hospital HAWK

Middlemore Hospital MIDM

Palmerston North Hospital PALM

Taranaki Base Hospital TARA

Waikato Hospital WKTO

Wellington Hospital WELN

Whangarei Area Hospital WHAN

Waitemata WMAT


Auckland City Hospital AUCK

Director - Dr Ian Dittmer

Park Road

Grafton, Auckland

Christchurch Hospital CHCH

Director - Dr David McGregor

Riccarton Avenue

Christchurch

Starship Children’s Hospital STAR

Director - Dr William Wong

Park Road

Grafton, Auckland

Wellington Hospital WELN

Director - Dr Grant Pidgeon

Riddiford Street

Newtown, Wellington South


Auckland Home Training Unit AHOM

Bay of Islands Hospital BAYI

Carrington Satellite CARR

Grafton Training Unit GRAF

Greenlane Hospital GLNE

Kaitaia Hospital KAIT

Kawakawa Hospital KAWA

Manukau Satellite MANU

Nephrocare NEPH

Nelson Hospital NELS

Porirua Community Dialysis PORI

Rotarua Hospital ROTO

Tauranga Hospital TAUR

Waitakere Satellite WAIT

HOSPITALS

xvii


Publications in peer-reviewed journals based substantially on data from ANZDATA and released during the period of data covered by this report and during 2011 are listed below.

PUBLICATIONS

2013 Tang W, Bose B, McDonald SP, Hawley CM, Badve SV, Boudville N, et al. The Outcomes of Patients with ESRD and ANCA-Associated Vasculitis in Australia and New Zealand. Clin J Am Soc Nephrol. 2013 May;8(5):773-80. McDonald SP, Russ GR. Australian registries-ANZDATA and ANZOD. Transplantation reviews (Orlando, Fla). 2013 Apr;27(2):46-9. Shahir AK, Briggs N, Katsoulis J, Levidiotis V. An observational outcomes study from 1966-2008, examining pregnancy and neonatal outcomes from dialysed women using data from the ANZDATA Registry. Nephrology (Carlton, Vic). 2013 Apr;18(4):276-84. Marshall MR, van der Schrieck N, Lilley D, Supershad SK, Ng A, Walker RC, et al. Independent community house hemodialysis as a novel dialysis setting: an observational cohort study. Am J Kidney Dis. 2013 Apr;61(4):598-607. Sparke C, Moon L, Green F, Mathew T, Cass A, Chadban S, et al. Estimating the total incidence of kidney failure in Australia including individuals who are not treated by dialysis or transplantation. Am J Kidney Dis. 2013 Mar;61(3):413-9. Tang W, McDonald SP, Hawley CM, Badve SV, Boudville NC, Brown FG, et al. Anti-glomerular basement membrane antibody disease is an uncommon cause of end-stage renal disease. Kidney Int. 2013 Mar;83(3):503-10. Vacher-Coponat H, McDonald S, Clayton P, Loundou A, Allen RDM, Chadban SJ. Inferior early posttransplant outcomes for recipients of right versus left deceased donor kidneys: an ANZDATA registry analysis. Am J Transplant. 2013 Feb;13(2):399-405. Tang W, McDonald SP, Hawley CM, Badve SV, Boudville N, Brown FG, et al. End-stage renal failure due to amyloidosis: outcomes in 490 ANZDATA registry cases. Nephrol Dial Transplant. 2013 Feb;28(2):455-61. Lim WH, Clayton P, Wong G, Campbell SB, Cohney S, Russ GR, et al. Outcomes of Kidney Transplantation From Older Living Donors. Transplantation. 2013 Jan 15;95(1):106-13. Grace BS, Clayton PA, Cass A, McDonald SP. Transplantation rates for living- but not deceased-donor kidneys vary with socioeconomic status in Australia. Kidney Int. 2013 Jan;83(1):138-45. Krishnasamy R, Badve SV, Hawley CM, McDonald SP, Boudville N, Brown FG, et al. Daily Variation in Death in Patients Treated by Long-term Dialysis: Comparison of In-Center Hemodialysis to Peritoneal and Home Hemodialysis. Am J Kidney Dis. 2013 Jan;61(1):96-103. Cho Y, Badve SV, Hawley CM, McDonald SP, Brown FG, Boudville N, et al. Effects of climatic region on peritonitis risk, microbiology, treatment, and outcomes: a multicenter registry study. Perit Dial Int. 2013 Jan;33(1):75-85. Hibberd AD, Trevillian PR, Wlodarczyk JH, Kemp DG, Stein AM, Gillies AHB, et al. Effect of immunosuppression for primary renal disease on the risk of cancer in subsequent renal transplantation: a population-based retrospective cohort study. Transplantation Journal. 2013 Jan;95(1):122-7. Wong G, Turner RM, Chapman JR, Howell M, Lim WH, Webster AC, et al. Time on dialysis and cancer risk after kidney transplantation. Transplantation Journal. 2013 Jan;95(1):114-21.

xviii


Grace BS, Kennedy SE, Clayton PA, McDonald SP. Racial disparities in paediatric kidney transplantation. Pediatr Nephrol. 2013 Aug 9. Le Page AK, Mackie FE, McTaggart SJ, Kennedy S. Cytomegalovirus & Epstein Barr Virus Serostatus as a predictor of the long term Outcome of Kidney Transplantation. Nephrology (Carlton). 2013 Aug 8. doi: 10.1111/nep.12149. Gallagher MP, Kelly PJ, Jardine M, Perkovic V, Cass A, Craig JC, et al. Long-term cancer risk of immunosuppressive regimens after kidney transplantation. J Am Soc Nephrol. 2010 May;21(5):852–8. Wyld ML, et al., Pregnancy outcomes for kidney transplant recipients.Am J Transplant. 2013 Jesudason S, et al., Pregnancy Outcomes According to Dialysis Commencing Before or After Conception in Women with ESRD.Clin J Am Soc Nephrol. 2013 Longmore DK, et al., Post-transplant lymphoproliferative disorder: no relationship to recombinant human growth hormone use in Australian and New Zealand pediatric kidney transplant recipients.Pediatr Transplant. 2013 Grace BS, et al., Does equal care give equal outcomes?Kidney Int. 2013 Grace BS, et al., Racial disparities in paediatric kidney transplantation.Pediatr Nephrol. 2014 Le Page AK, et al., Cytomegalovirus & Epstein Barr Virus Serostatus as a predictor of the long term Outcome of Kidney Transplantation.Nephrology (Carlton). 2013 Gray NA, et al., Data quality of the Australia and New Zealand Dialysis and Transplant Registry: a pilot audit.Nephrology (Carlton). 2013 McDonald SP, et al., Australian registries-ANZDATA and ANZOD.Transplant Rev (Orlando). 2013 Shahir AK, et al., An observational outcomes study from 1966-2008, examining pregnancy and neonatal outcomes from dialysed women using data from the ANZDATA Registry.Nephrology (Carlton). 2013 Jesudason S, Grace BS, McDonald SP, Pregnancy Outcomes According to Dialysis Commencing Before or After Conception in Women with ESRD. Clin J Am Soc Nephrol. 2013 Nov 14. [Epub ahead of print], PMID: 24235285 [PubMed - as supplied by publisher] Wyld ML, Clayton PA, Jesudason S, Chadban SJ, Alexander SI, Pregnancy outcomes for kidney transplant recipients. Am J Transplant. 2013 Dec;13(12):3173-82. doi: 10.1111/ajt.12452. Epub 2013 Oct 8. PMID: 24266970 [PubMed - in process] Longmore DK, Conwell LS, Burke JR, McDonald SP, McTaggart SJ, Post-transplant lymphoproliferative disorder: No relationship to recombinant human growth hormone use in Australian and New Zealand pediatric kidney transplant recipients. Pediatr Transplant. 2013 Dec;17(8):731-6. doi: 10.1111/petr.12167. PMID: 24164826 [PubMed - in process] Cho Y, Badve SV, Hawley CM, McDonald SP, Brown FG, Boudville N, Bannister KM, Clayton PA, Johnson DW, Association of Biocompatible Peritoneal Dialysis Solutions with Peritonitis Risk, Treatment, and Outcomes. Clin J Am Soc Nephrol. 2013 Aug 15. [Epub ahead of print] PMID: 23949232 [PubMed - as supplied by publisher] Grace BS, Kennedy SE, Clayton PA, McDonald SP, Racial disparities in paediatric kidney transplantation. Pediatr Nephrol. 2013 Aug 9. [Epub ahead of print] PMID: 23928908 [PubMed - as supplied by publisher] Le Page AK, Mackie FE, McTaggart SJ, Kennedy S, Cytomegalovirus & Epstein Barr Virus Serostatus as a predictor of the long term Outcome of Kidney Transplantation. Nephrology (Carlton). 2013 Aug 8. doi: 10.1111/nep.12149. [Epub ahead of print] PMID: 23927085 [PubMed - as supplied by publisher] Gray NA, Mahadevan K, Campbell VK, Noble EP, Anstey CM, Data quality of the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA): a pilot audit. Nephrology (Carlton). 2013 Jul 11. doi: 10.1111/nep.12126. [Epub ahead of print] PMID: 23841726 [PubMed - as supplied by publisher]

PUBLICATIONS

xix


Tang W, Bose B, McDonald SP, Hawley CM, Badve SV, Boudville N, et al. The Outcomes of Patients with ESRD and ANCA-Associated Vasculitis in Australia and New Zealand. Clin J Am Soc Nephrol. 2013 May;8(5):773-80. McDonald SP, Russ GR. Australian registries-ANZDATA and ANZOD. Transplantation reviews (Orlando, Fla). 2013 Apr;27(2):46-9. Shahir AK, Briggs N, Katsoulis J, Levidiotis V. An observational outcomes study from 1966-2008, examining preg-nancy and neonatal outcomes from dialysed women using data from the ANZDATA Registry. Nephrology (Carlton, Vic). 2013 Apr;18(4):276-84. Marshall MR, van der Schrieck N, Lilley D, Supershad SK, Ng A, Walker RC, et al. Independent community house hemodialysis as a novel dialysis setting: an observational cohort study. Am J Kidney Dis. 2013 Apr;61(4):598-607. Sparke C, Moon L, Green F, Mathew T, Cass A, Chadban S, et al. Estimating the total incidence of kidney failure in Australia including individuals who are not treated by dialysis or transplantation. Am J Kidney Dis. 2013 Mar;61(3):413-9. Tang W, McDonald SP, Hawley CM, Badve SV, Boudville NC, Brown FG, et al. Anti-glomerular basement mem-brane antibody disease is an uncommon cause of end-stage renal disease. Kidney Int. 2013 Mar;83(3):503-10. Vacher-Coponat H, McDonald S, Clayton P, Loundou A, Allen RDM, Chadban SJ. Inferior early posttransplant out-comes for recipients of right versus left deceased donor kidneys: an ANZDATA registry analysis. Am J Transplant. 2013 Feb;13(2):399-405. Tang W, McDonald SP, Hawley CM, Badve SV, Boudville N, Brown FG, et al. End-stage renal failure due to amy-loidosis: outcomes in 490 ANZDATA registry cases. Nephrol Dial Transplant. 2013 Feb;28(2):455-61. Lim WH, Clayton P, Wong G, Campbell SB, Cohney S, Russ GR, et al. Outcomes of Kidney Transplantation From Older Living Donors. Transplantation. 2013 Jan 15;95(1):106-13. Grace BS, Clayton PA, Cass A, McDonald SP. Transplantation rates for living- but not deceased-donor kidneys vary with socioeconomic status in Australia. Kidney Int. 2013 Jan;83(1):138-45. Krishnasamy R, Badve SV, Hawley CM, McDonald SP, Boudville N, Brown FG, et al. Daily Variation in Death in Patients Treated by Long-term Dialysis: Comparison of In-Center Hemodialysis to Peritoneal and Home Hemodial-ysis. Am J Kidney Dis. 2013 Jan;61(1):96-103. Cho Y, Badve SV, Hawley CM, McDonald SP, Brown FG, Boudville N, et al. Effects of climatic region on peritonitis risk, microbiology, treatment, and outcomes: a multicenter registry study. Perit Dial Int. 2013 Jan;33(1):75-85. Hibberd AD, Trevillian PR, Wlodarczyk JH, Kemp DG, Stein AM, Gillies AHB, et al. Effect of immunosuppression for primary renal disease on the risk of cancer in subsequent renal transplantation: a population-based retrospec-tive cohort study. Transplantation Journal. 2013 Jan;95(1):122-7. Wong G, Turner RM, Chapman JR, Howell M, Lim WH, Webster AC, et al. Time on dialysis and cancer risk after kidney transplantation. Transplantation Journal. 2013 Jan;95(1):114-21.

PUBLICATIONS

xx


DATA COLLECTION FORM

xxi

ANZDATA Registry 2013 Report _____________________________________________________________________________________ DATA COLLECTION FORM

This page is intentionally left blank

Kylie Hurst

Philip Clayton

Stephen McDonald

2013

ANNUAL REPORT SUMMARY

2013 Annual Report—36th Edition

XXIV


Chapter 1 - Stock and Flow There were 20,766 (919 per million population) receiving

renal replacement therapy (RRT) at 31st Dec 2012.

Of these 9320 (413 per million) had a functioning kidney transplant and 11,446 (507 per million) were receiving dialysis treatment.

Chapter 7 - Transplant Waiting list There were 1087 active patients on the deceased donor

kidney waiting list at the 1Jan and 1065 active on 31 Dec 2012. 736 were made active during the year and 153 were taken off the list, 6 died.

The numbers of both dialysis patients and transplants vary with age; As expected, numbers listed 65 years or older are much lower than for younger age groups, and the proportion removed from the list is higher.

Chapter 2 - New Patients 2534 people commenced RRT in Australia in 2012(112 per

million per year).

Incidence rates have stabilized over the past five years.

The mean age of patients entering programs in Australia in 2012 was 60 years and the median 62 years.

36% of all new patients had diabetic nephropathy attributed as their Cause of end stage renal disease, 19% had glomerulonephritis and 12% hypertension.

Chapter 8 - Transplantation The 845 transplant operations performed in 2012 represent a

slight increase over 2011. This was primarily driven by an increase in the number of deceased donor kidney transplants, offsetting a continuing fall in living donor numbers.

The 2012 numbers represent a transplant rate of 37 per million population per year, unchanged from 2011.

The median age of transplant recipients in 2012 was 49 years.

There have been 20,704 transplant operations performed on 17,135 patients since 1963. Of these, 9320 grafts were functioning at 31st December 2012.

Chapter 3 - Deaths The mortality rate per 100 patient years was 12.7 for

dialysis dependent patients and 1.8 for those with a functioning kidney transplant.

Of the 1,440 deaths among dialysis dependent patients in 2012, 34% were due to withdrawal from treatment, 31% were due to cardiovascular causes, 8% to infection.

In Australia there is steady improvement in mortality rates in most age groups over time.

Chapter 9 - Kidney Donation In Australia there has been a large increase in the number

of deceased donors since 2008, driven by an increase in expanded criteria (ECD) and in particular cardiac death (DCD) donors.

In Australia the mean deceased donor age has increased steadily from 36 years in 1993 to 46 years in 2012.

There were 238 living donor kidney transplants performed in 2012 in Australia, representing 28% of all transplant operations.

The proportion of all primary living donor transplants performed “pre-emptively” in Australia was 36%.

Chapter 4 - Method and Location of Dialysis There has been an increase of 411 (4%) in the total

number of prevalent dialysis patients.

Twelve percent of all prevalent dialysis patients were using automated peritoneal dialysis, a further 7% continuous ambulatory peritoneal dialysis, 22% hospital based haemodialysis, 49% satellite haemodialysis and 9% home haemodialysis.

Chapter 10 - Cancer Report There is now consistent evidence showing an increased

risk of cancer by at least 1.5 and 2-fold for people on dialysis and with kidney transplants, respectively.

Cancer is also second to cardiovascular disease as the major cause of mortality and morbidity in these patients.

Cancer can occur de novo or recur after transplantation.

Chapter 5 - Haemodialysis

There were 9,219 patients receiving HD treatment at 31st December 2012, an increase of 3%; of these 28% were hospital based, 61% were in satellite centres and11% at home.

A total of 1,788 patients received HD for the first time during the year, a slight increase from previous years.

There were 539 transplant operations to people receiving HD treatment, 6% of all HD patients dialysing and 8% of those patients < 65 years.

Chapter 11 - Paediatric Report Overall, glomerulonephritis remains the most common

cause of ESKD in children and adolescents (29%) but causes vary significantly with age. In young children renal hypoplasia/dysplasia is the most common cause while glomerulonephritis is a common cause of ESKD in adolescents.

Around 20% of children and adolescents receive pre-emptive kidney transplants. Of the remainder, similar numbers commence renal replacement therapy with haemodialysis peritoneal dialysis.

Chapter 6 - Peritoneal Dialysis Peritoneal dialysis was used to treat 19% of all dialysis

patients in 2012 (APD-1374,CAPD-853,total 11,446).

There were 977 new peritoneal dialysis patients in the calendar year 2012; of these 658 patients (67%) started renal replacement therapy with peritoneal dialysis and 319 (33%) had previously been treated with haemodialysis or a transplant.

Median time to first peritonitis was 24 months, with 37% of patients completely free of peritonitis at three years

Chapter 12 - End-Stage Kidney Disease Among Indigenous Peoples of Australia and New Zealand

A total of 254 Aboriginal and Torres Strait Islander People commenced dialysis in Australia during 2012.

Over the period 2002-12 there was an increase in the number of transplants from deceased donors. Numbers from living donors remain extremely low.

AUSTRALIA

KEY SUMMARY POINTS

XXV


Chapter 1 - Stock and Flow

There were 3,862 (877 per million population) receiving renal replacement therapy (RRT) at 31st Dec 2011

Of these 1481(336 per million) had a functioning kidney transplant and 2,381 (541 per million) were receiving dialy-sis treatment.

Chapter 7 - Transplant Waiting list We anticipate incorporating detailed NZ waiting list stack

and flow analyses in next year’s Report.

Chapter 2 - New Patients

477 people commenced RRT in New Zealand in 2011 (108 per million per year).

The mean age of patients entering programs in new Zea-land in 2011 was 57.5 years and the median 59.1 years.

42% of all new patients had diabetic nephropathy attribut-ed as their Cause of end stage renal disease, 24% had glomerulonephritis and 11% hypertension.

Chapter 8 - Transplantation The number of transplant operations (118) performed in

2011 represents a transplant rate of 27 per million popula-tion per year compared with 25 in 2010 .

The median age of transplant recipients in 2011 was 50 years.

There have been 3,746 operations performed on 3,188 patients since 1965 with 1,481 grafts still functioning at 31st

December 2011

Chapter 3 - Deaths

The mortality rate per 100 patient years was 15.5 for dialy-sis dependent patients and 2.8 for those with a functioning kidney transplant.

Of the 412 deaths among dialysis dependent patients in 2011, 25% were due to withdrawal from treatment, 32% were due to cardiovascular causes, 13% to infection.

Chapter 9 - Kidney Donation The deceased donor numbers are steady and the propor-

tion of ECD and DCD donors are much lower than in Aus-tralia.

In New Zealand the mean donor age in 2011 was 36 years.

The number of living donor transplants decreased by 5% (57 donors) in New Zealand in 2011.

The proportion of pre-emptive primary living donor trans-plants in New Zealand was 23% in 2011.

Chapter 4 - Method and Location of Dialysis There were 2381 prevalent dialysis patients in 2011 which

is stable compared to previous years.

Together, hospital haemodialysis and satellite dialysis accounted for 48% of patients in 2011, the same as the previous two years. Satellite haemodialysis numbers de-creased 9% in 2011 (368 patients), after increases of 5% (396 patients) in 2010 and 8% (413 patients) in 2009.

Chapter 10 - Cancer Report Refer to Australian Summary points

Chapter 11 - Paediatric Report Refer to Australian Summary points

Chapter 5 - Haemodialysis There were 1,591 patients receiving treatment at 31st

December 2011, Hospital based HD (44%), satellite HD (29%) and home HD (27%) have all remained the same for the past three years.

There were 62 HD patients who received transplants in 2011 (47 in 2010). Four patients ≥ 65 years were trans-planted.

There were 403 patients who received HD for the first time in 2011, similar to previous years. Seventy eight percent were having their initial dialysis treatment, 20% were previ-ously dialysing with peritoneal dialysis and 2% were failed transplants.

Chapter 12 - End-Stage Kidney Disease Among Indigenous Peoples of Australia and New Zealand

The number of Maori and Pacific People starting dialysis decreased in 2011 (126 patients and 94 patients) respec-tively.

The number of transplants to Maori and Pacific Peoples recipients remains stable.

Chapter 6 - Peritoneal Dialysis

Peritoneal dialysis accounted for 33% of all dialysis patients and 64% of all patients dialysing at home.

There were 239 new peritoneal dialysis patients in the calendar year 2011; of these 147 patients started renal replacement therapy with peritoneal dialysis and 90 had previously been treated with haemodialysis or a transplant.

The median time to first peritonitis was 19.4 months, with 31% of patients free of peritonitis at three years.

NEW ZEALAND

KEY SUMMARY POINTS

XXVI


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1-1

ANZDATA Registry 2013 Report STOCK and FLOW _____________________________________________________________________________________

Blair Grace

Kylie Hurst

Stephen McDonald

Philip Clayton

CHAPTER 1

STOCK AND FLOW

2013 Annual Report—36th Edition

1-2

STOCK and FLOW ANZDATA Registry 2013 Report _____________________________________________________________________________________

Figure 1.2

Prevalent Patients 2008 - 2012 (Number Per Million Population at 31st December)

2008 2009 2010 2011 2012

Australia Total 17824 (834) 18512 (850) 19210 (871) 19913 (892) 20766 (919)

No. Transplants • # 7654 (358) 8047 (370) 8506 (386) 8878 (398) 9320 (413)

No. Dialysis Patients 10170 (476) 10465 (481) 10704 (485) 11035 (494) 11446 (507)

Proportion Home * 31% 30% 29% 28% 29%

Proportion Satellite HD 46% 47% 50% 51% 49%

Proportion CAPD/APD 22% 21% 20% 19% 19%

New Zealand Total 3456 (810) 3685 (854) 3828 (876) 3872 (879) 3993 (901)

No. Transplants • # 1350 (316) 1404 (325) 1440 (330) 1483 (337) 1524 (344)

No. Dialysis Patients 2106 (493) 2281 (529) 2388 (547) 2389 (542) 2469 (557)

Proportion Home * 52% 52% 53% 51% 50%

Proportion Satellite HD 19% 18% 17% 15% 16%

Proportion CAPD/APD 36% 35% 35% 33% 31%

• Country of Residence # Patients lost to follow up are not included

* Proportion of all patients dialysing currently receiving home-based treatment (either PD or HD)

The number of new patients in Australia increased slightly to 2534 in 2012. While there is variation in this rate from year to year, the rate remains stable from 2007. Reflecting both the changes in numbers of new patients and higher number of transplants, the number of prevalent dialysis patients (people receiving dialysis at the end of 2012) has slowly increased.

In New Zealand there was greater variability reflecting a smaller population base.

Rates of new and prevalent patients are shown in Figures 1.1 to 1.2 respectively. Further data about stock and flow are shown in Figures 1.6 to 1.14.

The overall number of new transplants (845) increased by 2.5% in 2012 similar to the number of new transplants in 2010. Recent years have seen substantial changes in the mix of living verses deceased donor transplants. Further information is shown in the transplant chapter. In 2012, there were 238 live donor transplants reported, a 6% decrease after the 14% decrease in 2011 (255 transplants).

In New Zealand the number of new transplants remained similar in 2012 (108 transplants), and numbers of live donor transplants (54) have decreased (by 3) from 2011.

Figure 1.1

Patient Flow Summary 2008 - 2012 (Number Per Million Population at 31st December)

* Country of Transplant

2008 2009 2010 2011 2012

Australia

Total New Patients 2551 (119) 2431 (112) 2330 (106) 2496 (112) 2534 (112)

Total Transplants * 813 (38) 773 (35) 846 (38) 825 (37) 845 (37)

Living Donor Transplants 354 327 296 255 238

Subsequent Transplants 105 99 102 81 98

Total Deaths 1677 1692 1598 1726 1606

Dialysis Patients 1493 1538 1414 1502 1440

Transplant Patients 184 154 184 224 166

New Zealand

Total New Patients 497 (116) 584 (135) 515 (118) 485 (110) 513 (116)

Total Transplants * 122 (29) 121 (28) 110 (25) 118 (27) 108 (24)

Living Donor Transplants 69 67 60 57 54

Subsequent Transplants 11 12 6 8 9

Total Deaths 388 365 354 413 384

Dialysis Patients 360 331 319 369 355

Transplant Patients 28 34 35 44 29

Notes: Figures for total transplants are by country of transplant. Figures for transplant deaths are by country of residence at time of death.

1-3


Figure 1.3

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New PatientsAustralia and New Zealand

Figure 1.5

-80

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Figure 1.4

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1-4


Figure 1.8

Prevalent Transplant/Dialysis Patients by Indigenous Racial Origin, 2008 - 2012

(Number Per Million Population Per Year) Race 2008 2009 2010 2011 2012

Aboriginal and Torres

Strait Islanders #

New Patients 251 (466) 196 (356) 206 (367) 256 (446) 254 (433)

Dialysis 1163 (2160) 1184 (2153) 1214 (2161) 1307 (2278) 1425 (2431)

Functioning Transplants * 159 (295) 160 (291) 177 (315) 190 (331) 193 (329)

Transplant Operations 31 (58) 24 (44) 28 (50) 28 (49) 20 (34)

Deaths 164 (305) 174 (316) 162 (288) 149 (260) 129 (220)

Māori ^

New Patients 157 (244) 177 (271) 155 (233) 129 (192) 167 (244)

Dialysis 689 (1072) 733 (1123) 761 (1146) 746 (1108) 773 (1130)



Deaths 152 (236) 126 (193) 114 (172) 131 (194) 128 (187)

Pacific People ^

New Patients 87 (274) 103 (315) 109 (325) 95 (275) 92 (261)

Dialysis 434 (1365) 490 (1500) 542 (1615) 568 (1646) 600 (1699)



Deaths 55 (173) 48 (147) 50 (149) 61 (177) 62 (176)

* By Transplanting Country # Aboriginal and Torres Strait Islanders Combined ^ Māori and Pacific People data collected from patients living in New Zealand only

The incidence rate among Australian Aboriginal, Māori and Pacific People is substantially higher than among non-indigenous people. Although interpretation is complicated by fluctuations from year to year, the incidence rate may have stabilised over the past 5-10 years after a steady rise since the 1980s. Compared with non-indigenous patients, lower rates of transplantation in indigenous patients contributes to higher rates of prevalent dialysis patients (Figure 1.8).

Figure 1.6

0

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Dial Tx Dial Tx Dial Tx Dial Tx Dial Tx

Prevalent Dialysis and TransplantAustralia (at 31 December)

Home HD Hosp / Sat HD PD Functioning Tx

Figure 1.7

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Home HD Hosp / Sat HD PD Functioning Tx

1-5


Figure 1.10

Prevalent Transplant and Dialysis Patients 1991 to 2012 Country of Transplant

(Number Per Million Population at 31 December)

Australia New Zealand Year Transplant # Dialysis Total Transplant # Dialysis Total

1991 3518 (204) 3138 (182) 6656 (385) 600 (172) 630 (180) 1230 (352)

1992 3729 (213) 3383 (193) 7112 (407) 671 (190) 674 (191) 1345 (381)

1993 3900 (221) 3703 (210) 7603 (430) 702 (197) 721 (202) 1423 (398)

1994 4095 (229) 4099 (230) 8194 (459) 729 (201) 784 (217) 1513 (418)

1995 4271 (236) 4518 (250) 8789 (486) 782 (213) 850 (231) 1632 (444)

1996 4483 (245) 4882 (267) 9365 (512) 822 (220) 934 (250) 1756 (471)

1997 4740 (256) 5190 (280) 9930 (536) 878 (232) 1017 (269) 1895 (501)

1998 4970 (266) 5536 (296) 10506 (562) 931 (244) 1126 (295) 2057 (539)

1999 5141 (272) 6019 (318) 11160 (590) 978 (255) 1230 (321) 2208 (576)

2000 5350 (279) 6409 (335) 11759 (614) 1020 (264) 1331 (345) 2351 (609)

2001 5572 (287) 6851 (353) 12423 (640) 1060 (273) 1462 (377) 2522 (650)

2002 5858 (298) 7263 (370) 13121 (668) 1113 (282) 1594 (404) 2707 (686)

2003 6089 (306) 7719 (388) 13808 (694) 1164 (289) 1711 (425) 2875 (714)

2004 6395 (318) 8004 (398) 14399 (715) 1218 (298) 1774 (434) 2992 (732)

2005 6656 (326) 8642 (424) 15298 (750) 1243 (301) 1878 (454) 3121 (755)

2006 6987 (338) 9263 (448) 16250 (785) 1256 (300) 1997 (477) 3253 (777)

2007 7251 (345) 9731 (463) 16982 (808) 1300 (307) 2071 (490) 3371 (797)

2008 7654 (358) 10170 (476) 17824 (834) 1350 (316) 2106 (493) 3456 (810)

2009 8047 (370) 10465 (481) 18512 (850) 1404 (325) 2281 (529) 3685 (854)

2010 8506 (386) 10704 (485) 19210 (871) 1440 (330) 2388 (547) 3828 (876)

2011 8878 (398) 11035 (494) 19913 (892) 1483 (337) 2389 (542) 3872 (879)

# Patients lost to follow-up are excluded

2012 9320 (413) 11446 (507) 20766 (919) 1524 (344) 2469 (557) 3993 (901)

Figure 1.9

National and State Stock and Flow 1-Jan-2012 to 31-Dec-2012 (31-Dec-2011 Figures)

State New Patients

Transplant Operations *

Deaths Dialysis

Dependent + Functioning

Transplants # * + Total Dialysis Transplant

Queensland 467 (451) 164 (154) 272 (315) 31 (47) 2085 (2012) 1810 (1717) 3895 (3729)

New South Wales 786 (780) 224 (217) 457 (482) 47 (80) 3707 (3574) 2640 (2524) 6347 (6098)

Aust. Capital Territory 64 (53) 16 (21) 36 (27) 4 (8) 269 (264) 226 (216) 495 (480)

Victoria 628 (602) 250 (255) 343 (338) 33 (38) 2792 (2704) 2493 (2352) 5285 (5056)

Tasmania 47 (52) 15 (23) 32 (23) 4 (1) 214 (204) 225 (221) 439 (425)

South Australia 202 (183) 78 (66) 114 (110) 26 (27) 733 (712) 952 (920) 1685 (1632)

Northern Territory 98 (83) 14 (11) 47 (49) 2 (4) 502 (464) 77 (68) 579 (532)

Western Australia 242 (292) 86 (87) 139 (158) 19 (19) 1144 (1101) 897 (860) 2041 (1961)

Australia 2534 (2496) 847 (834) 1440 (1502) 166 (224) 11446 (11035) 9320 (8878) 20766 (19913)

New Zealand 513 (485) 109 (121) 355 (369) 29 (44) 2469 (2389) 1524 (1483) 3993 (3872)

# Patients lost to follow-up are excluded * Resident State + Point Prevalence at 31 December

State by State rates are shown in Figure 1.9. Figures 1.10 to 1.14 deal with the number of prevalent dialysis and transplant patients, showing trends over the past 25 years (Figure 1.10) and state-by-state comparisons.

1-6


Figure 1.13

Comparison of Prevalent Transplant and Dialysis Dependent Patients 2008 - 2012

(Number Per Million Population at 31 December)

2008 2009 2010 2011 2012

Transplants #

Queensland 1505 (352) 1576 (361) 1649 (373) 1717 (384) 1810 (400)

New South Wales* 2195 (324) 2298 (335) 2435 (351) 2524 (361) 2640 (374)

Aust. Capital Territory* 199 (357) 199 (352) 213 (371) 216 (371) 226 (382)

Victoria 1914 (362) 2058 (381) 2210 (404) 2352 (425) 2493 (445)

Tasmania 181 (363) 194 (385) 206 (405) 221 (432) 225 (437)

South Australia 838 (525) 868 (538) 906 (556) 920 (562) 952 (578)

Northern Territory 74 (335) 67 (295) 69 (300) 68 (294) 77 (331)

Western Australia 748 (343) 787 (350) 818 (356) 860 (366) 897 (372)

Australia 7654 (358) 8047 (370) 8506 (386) 8878 (398) 9320 (413)

New Zealand 1350 (316) 1404 (325) 1440 (330) 1483 (337) 1524 (344)

#By Resident State and Country

Dialysis

Queensland 1885 (441) 1957 (448) 2004 (453) 2012 (450) 2085 (461)

New South Wales* 3363 (497) 3434 (501) 3494 (504) 3574 (511) 3707 (525)

Aust. Capital Territory* 235 (422) 239 (423) 245 (427) 264 (453) 269 (455)

Victoria 2486 (470) 2531 (469) 2616 (478) 2704 (489) 2792 (498)

Tasmania 179 (359) 199 (395) 192 (378) 204 (399) 214 (416)

South Australia 630 (394) 683 (423) 677 (415) 712 (435) 733 (445)



Australia 10170 (476) 10465 (481) 10704 (485) 11035 (494) 11446 (507)

New Zealand 2106 (493) 2281 (529) 2388 (547) 2389 (542) 2469 (557)

* NSW population excludes residents of the Southern Area Health Service * ACT population includes residents of the Southern Area Health Service

(Medical services in the ACT service this Southern Area Region) Transplanted patients lost to follow up have been excluded

There is substantial variation in prevalence of RRT and transplantation between states rates leading to differences between dialysis and transplantation (Figures 1.11 to 1.14). The proportionally large number per million population of dialysis patients in the Northern Territory reflects the higher proportion of indigenous population.

Figure 1.12

316

493

325

529

330

547

337

542

344

557

2008 2009 2010 2011 2012

Prevalent Patients per Million Population

New Zealand

Transplant Dialysis

Figure 1.11

358

476

370

481

386

485398

494413

507

2008 2009 2010 2011 2012


Australia

Transplant Dialysis

1-7


Comparison of Transplant and Dialysis Dependent Patients 2008 - 2012

Note: Y scales vary between states

Figure 1.14

357422

352423

371427

371453

382455

2008 2009 2010 2011 2012


Australian Capital Territory

Transplant Dialysis

324

497

335

501

351

504

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525

2008 2009 2010 2011 2012


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Transplant Dialysis

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1801

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1838

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2006

331

2159

2008 2009 2010 2011 2012


Northern Territory

Transplant Dialysis

352

441361

448373

453384

450400

461

2008 2009 2010 2011 2012


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Transplant Dialysis

525

394

538

423

556

415

562

435

578

445

2008 2009 2010 2011 2012


South Australia

Transplant Dialysis

363 359 385 395 405 378432

399437 416

2008 2009 2010 2011 2012


Tasmania

Transplant Dialysis

362

470

381

469404

478425

489445

498

2008 2009 2010 2011 2012


Victoria

Transplant Dialysis

343

456

350

447

356

451366

468

372

475

2008 2009 2010 2011 2012


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Transplant Dialysis

1-8


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Blair Grace

Stephen McDonald

Kylie Hurst

Philip Clayton

CHAPTER 2

NEW PATIENTS (Commencing treatment in 2012)


2-2

NEW PATIENTS ANZDATA Registry 2013 Report _____________________________________________________________________________________

INTAKE OF NEW PATIENTS

There were 2534 patients who commenced treatment for end-stage renal failure in Australia in 2012, a rate of 112 per million population.

Incidence rates have stabilised over the past 5 years.

In New Zealand, the number of new patients commencing renal replacement treatment was 513, a rate of 116 per million of population. This rate has been essentially stable since 2007.

AGE OF NEW PATIENTS

In Australia in 2012, all age groups under 85 showed stable or decreased rates for acceptance of new patients compared with 2011 (Figure 2.2). The 85+ age group showed an increase compared with 2011.

The largest decrease was in the 75-79 year group, from 536 to 447 per million (Figure 2.4). The mean age of patients entering programs in Australia in 2012 was 60 years and the median 62 years (Figure 2.5).

In New Zealand, the mean age of patients entering was 56 years and the median 58 years (Figure 2.5).

The youngest age starting renal replacement therapy in Australia was under 1 year of age and the oldest patient was 99 years old.

In New Zealand, the youngest was 2 years of age and the oldest was 85 years old.

Figure 2.1

Annual Intake of New Patients 2008 - 2012 (Number Per Million Population)

2008 2009 2010 2011 2012

Queensland 534 (125) 490 (112) 451 (102) 451 (101) 467 (103)

New South Wales 814 (120) 766 (112) 722 (104) 780 (111) 786 (111)

Aust. Capital Territory 61 (109) 41 (73) 53 (92) 53 (91) 64 (108)

Victoria 539 (102) 549 (102) 575 (105) 602 (109) 628 (112)

Tasmania 54 (108) 58 (115) 47 (92) 52 (102) 47 (91)

South Australia 185 (116) 207 (128) 180 (110) 183 (112) 202 (123)



Australia 2551 (119) 2431 (112) 2330 (106) 2496 (112) 2534 (112)

New Zealand 497 (116) 584 (135) 515 (118) 485 (110) 513 (116)

Figure 2.2

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Figure 2.3

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2-3

ANZDATA Registry 2013 Report NEW PATIENTS _____________________________________________________________________________________

Within the older age groups in Australia, only the 65-69 and 75-79 year age groups decreased in numbers in 2012 (Figure 2.4).

In New Zealand there were decreases in the 65-69, 70-74, 80-84 and ≥85 age groups in 2012.

Rates in most age groups ≥70 years were higher in Australia than in New Zealand, particularly for those 75 years or older.

STATE OF ORIGIN OF NEW PATIENTS

The age at start of dialysis varied little between States (Figure 2.5) except in the Northern Territory. The highest acceptance rates were in the Northern Territory (410 per million) ( Figure 2.6).

Figure 2.5

Age and Gender of New Patients 1-Jan-2012 to 31-Dec-2012 Number of Patients

Age Groups Years

QLD (n=467)

NSW (n=786)

ACT (n=64)

VIC (n=628)

TAS (n=47)

SA (n=202)

NT (n=98)

WA (n=242) AUST

(n=2534) NZ

(n=513)

F M F M F M F M F M F M F M F M F M F M

00-04 1 0 1 4 0 0 2 3 0 0 0 2 0 0 0 0 4 9 0 1

05-14 3 4 7 6 0 0 1 3 0 0 0 0 0 0 0 1 11 14 3 5

15-24 10 7 3 15 0 0 4 9 0 0 2 1 0 0 2 3 21 35 11 10

25-34 13 15 17 25 3 1 15 10 1 0 5 6 4 6 5 9 63 72 5 18

35-44 13 35 20 38 2 5 24 32 2 2 12 17 13 7 3 19 89 155 15 30

45-54 32 35 44 74 1 4 30 56 1 5 14 22 21 11 17 29 160 236 40 67

55-64 53 70 70 98 4 10 56 89 4 4 12 31 12 14 19 30 230 346 51 109

65-74 34 58 88 103 6 10 61 110 6 8 13 25 3 2 17 33 228 349 38 69

75-84 24 41 49 102 5 13 31 81 3 10 14 24 1 2 9 33 136 306 13 27

>=85 5 14 5 17 0 0 3 8 1 0 0 2 0 2 6 7 20 50 1 0

Total 188 279 304 482 21 43 227 401 18 29 72 130 54 44 78 164 962 1572 177 336

Mean age 56.9 59.8 60.4 60.3 61.6 64.5 59.3 61.9 64.4 67.4 57.7 59.5 49.4 53.6 60.7 60.1 58.7 60.6 55.3 56.3

Mean age 58.6 60.3 63.5 61 66.2 58.9 51.3 60.3 59.9 55.9

Median age 61.3 63.6 65.4 63.8 70.8 59.5 51 61.1 62.3 58.3

Age range 0.6 - 92.1 0.7 - 98.1 32.4 - 84.6 0.3 - 89 33.7 - 85.5 0.3 - 90.1 27.1 - 99.7 5.9 - 89.9 0.3 - 99.7 2.3 - 85.4

Min.in.days 220 263 11813 96 12316 123 9896 2140 831

Figure 2.4

Acceptance of Elderly New Patients 2008 - 2012 (Number Per Million Population)

Country Age Groups 2008 2009 2010 2012

Australia

60-64 years 289 (257) 271 (232) 279 (231) 314 (246)

65-69 years 302 (364) 288 (333) 255 (281) 289 (289)

70-74 years 316 (478) 303 (446) 290 (414) 288 (390)

75-79 years 285 (517) 296 (537) 271 (491) 252 (447)

80-84 years 194 (458) 169 (392) 155 (353) 190 (423)

>=85 years 61 (172) 66 (179) 77 (200) 70 (166)

Total 1447 (367) 1393 (343) 1327 (317) 1403 (316)

New Zealand

60-64 years 65 (307) 72 (325) 93 (404) 82 (346)

65-69 years 65 (392) 75 (437) 70 (397) 62 (325)

70-74 years 51 (405) 66 (507) 48 (350) 45 (295)

75-79 years 29 (277) 49 (468) 33 (314) 27 (249)

80-84 years 7 (90) 16 (202) 18 (223) 13 (155)

>=85 years 0 (0) 4 (60) 3 (43) 1 (13)

Total 217 (290) 282 (364) 265 (331) 230 (271)

2011

289 (233)

292 (307)

278 (387)

299 (536)

161 (363)

63 (156)

1382 (320)

61 (257)

75 (416)

47 (324)

22 (208)

19 (230)

5 (68)

229 (278)

2-4


Figure 2.6 Incidence rates (95% confidence intervals) for new RRT patients by State. Note the Y axis scales for each State are different. ACT population data includes the adjacent area of NSW (serviced by Canberra).

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INCIDENCE RATES FOR NEW RRT PATIENTS BY STATE

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2-5


Figure 2.7 Incidence rates (95% confidence intervals) for new RRT patients by state and age groups. Note the Y axis scales for each state are different. ACT population data includes the adjacent area of NSW (serviced by Canberra).

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illio

n p

er

yea

r)

2006 2007 2008 2009 2010 2011 2012

Year

65+45-6425-44

<25

New RRT Rates By Age GroupVictoria

2-6


LATE REFERRAL

In total 21% of all new patients in Australia and 15% in New Zealand were referred “late” to nephrological care, i.e. less than three months before first treatment (Figure 2.8). There is some variation with age, and patterns differ between Australia and New Zealand (Figure 2.9). Late referral rates have been essentially stable for a number of years (Figure 2.10). Among the states/territories, the lowest rate was 2% in the Tasmania ranging to 35% in Northern Territory. Variation with racial origin is shown in Figure 2.11. Higher rates are seen among ATSI, Pacific People and Maori’s.

Figure 2.8

Late Referral of New Patients Number of Patients (% Patients)

Primary Renal Disease

QLD NSW ACT VIC TAS SA NT WA AUST NZ

LATE REFERRAL

Analgesic 2 2 0 2 0 0 0 0 6 3

Type 1 diabetes 2 9 0 5 0 1 0 3 20 1

Type 2 diabetes 27 42 4 32 0 7 25 13 150 24

Glomerulonephritis 19 39 3 30 0 5 2 14 112 17

Hypertension 16 21 4 15 0 2 4 9 71 10

Miscellaneous 26 49 1 33 1 4 1 8 123 16

Polycystic 2 6 0 1 0 2 0 0 11 2

Reflux 3 3 1 0 0 0 0 4 11 1

Uncertain 6 14 1 10 0 2 2 4 39 5

Subtotals 103 (22%) 185 (24%) 14 (22%) 128 (20%) 1 (2%) 23 (11%) 34 (35%) 55 (23%) 543 (21%) 79 (15%)

NOT LATE REFERRAL

Analgesic 8 15 0 2 0 4 0 0 29 1

Type 1 diabetes 23 31 3 21 2 10 2 5 97 11

Type 2 diabetes 93 172 16 174 11 51 39 62 618 209

Glomerulonephritis 58 88 8 107 9 44 3 39 356 86

Hypertension 45 71 8 48 5 16 3 28 224 37

Miscellaneous 64 100 5 63 8 21 2 13 276 38

Polycystic 25 29 3 31 5 13 2 4 112 24

Reflux 11 18 1 15 2 4 1 3 55 7

Uncertain 24 32 5 24 4 12 3 5 109 10

Subtotals 351 (75%) 556 (71%) 49 (77%) 485 (77%) 46 (98%) 175 (87%) 55 (56%) 159 (66%) 1876 (74%) 423 (82%)

Subtotals 13 (3%) 45 (6%) 1 (2%) 15 (2%) 0 (0%) 4 (2%) 9 (9%) 28 (12%) 115 (5%) 11 (2%)

Total (100%) 467 786 64 628 47 202 98 242 2534 513

NOTE; Diabetes Type 2 non insulin requiring and Diabetes Type 2 requiring insulin are now combined

MISSING / UNKNOWN

2-7


Figure 2.10

Late Referral - All Modes of Treatment Including Pre-emptive Transplants 2008 to 2012

Country Years

2008 2009 2010 2011 2012

Australia

Not late referral 1996 (78%) 1921 (79%) 1806 (78%) 1925 (77%) 1876 (74%)

Late referral 554 (22%) 508 (21%) 518 (22%) 559 (22%) 543 (21%)

Missing / Undefined 1 (0%) 2 (0%) 6 (0%) 12 (0%) 115 (5%)

Total 2551 2431 2330 2496 2534

New Zealand


Late referral 111 (22%) 97 (17%) 83 (16%) 105 (22%) 79 (15%)

Missing / Undefined 1 (0%) 1 (0%) 1 (0%) 1 (0%) 11 (2%)

Total 497 584 515 485 513

Notes: Late referral is not defined by px less than 90 days old in the 2012 figures.

Figure 2.11

Late Referral - All Modes of Treatment Including Pre-emptive Transplants

By Race 2008 to 2012

Country Race

Asian Aboriginal/TSI Caucasian Maori Pacific

People Other

Australia

Not Late Referred 852 (76%) 853 (73%) 7392 (78%) 85 (71%) 161 (72%) 181 (66%)

Late Referred 257 (23%) 296 (25%) 1975 (21%) 31 (26%) 61 (27%) 62 (22%)

Total 1116 1163 9444 119 224 276

New Zealand

Not Late Referred 177 (85%) - 901 (83%) 611 (78%) 396 (81%) 19 (83%)

Late Referred 32 (15%) - 184 (17%) 168 (21%) 89 (18%) 2 (9%)

Total 209 - 1091 785 486 23

Notes: Maori and Pacific Peoples who were resident and commenced treatment in Australia are also shown.

Missing/undefined 7 (1%) 14 (1%) 77 (1%) 3 (3%) 2 (1%) 33 (12%)

Missing/undefined 0 (0%) - 6 (1%) 6 (1%) 1 (0%) 2 (9%)

Figure 2.9

Late Referral - All Modes of Treatment Including Pre-emptive Transplants New Patients 1-Jan-2008 to 31-Dec-2012

Country Age Groups

Total 0-4 25-34 45-54 65-74 75-84 >=85

Australia


235 (70%) 9524 (77%)

Late referral 7 (12%) 149 (26%) 401 (21%) 602 (21%) 484 (21%) 100 (30%) 2682 (22%)

Total 58 582 1941 2901 2272 337 12342

New Zealand

Not late referral 6 (55%) 86 (76%) 437 (79%) 510 (84%) 193 (83%) 12 (92%) 2104 (81%)

Late referral 4 (36%) 27 (24%) 115 (21%) 91 (15%) 40 (17%) 1 (8%) 475 (18%)

Total 11 113 555 604 233 13 2594

15-24

175 (63%)

99 (35%)

280

48 (60%)

31 (39%)

80

35-44

854 (75%)

270 (24%)

1137

190 (75%)

61 (24%)

252

55-64

2157 (79%)

549 (20%)

2728

611 (86%)

95 (13%)

712

5-14

75 (71%)

21 (20%)

106

11 (52%)

10 (48%)

21

Unknown / Undefined 9 (16%) 10 (9%) 6 (2%) 12 (2%) 13 (1%) 28 (1%) 22 (1%) 19 (1%) 15 (1%) 2 (1%) 136 (1%)

Unknown / Undefined 1 (9%) 0 (0%) 1 (1%) 0 (0%) 1 (0%) 3 (1%) 6 (1%) 3 (0%) 0 (0%) 0 (0%) 15 (1%)

2-8


CO-MORBID CONDITIONS

Co-morbid conditions at entry to RRT are shown in Figures 2.12 - 2.18. In Australia, the proportion of people with reported coronary artery disease, chronic lung disease and peripheral vascular disease at the onset of dialysis has decreased (Figure 2.13). See Appendix II and III for further analyses of co-morbid conditions.

Figure 2.12

Co-morbid Conditions at Entry to Program 2012 Number of Patients (% Patients)

Country

Chronic Lung

Disease

Coronary Artery

Disease

Peripheral Vascular Disease

Cerebro- Vascular Disease

Smoking Diabetes (Including

Diabetic Nephropathy )

Australia n=2534

Yes 306 (12%) 768 (30%) 409 (16%) 264 (10%) Current 297 (12%) Type 1 141 (6%)

Suspected 95 (4%) 164 (6%) 150 (6%) 77 (3%) Former 1055 (42%) Type 2 1049 (41%)

No 2133 (84%) 1602 (63%) 1975 (78%) 2193 (87%) Never 1091 (43%) No 1344 (53%)

Unknown 0 (0%) 0 (0%) 0 (0%) 0 (0%) Unknown 91 (4%) Unknown 0 (0%)

New Zealand n=513

Yes 65 (13%) 118 (23%) 68 (13%) 58 (11%) Current 77 (15%) Type 1 16 (3%)

Suspected 9 (2%) 31 (6%) 18 (4%) 18 (4%) Former 195 (38%) Type 2 276 (54%)

No 439 (86%) 364 (71%) 427 (83%) 437 (85%) Never 232 (45%) No 221 (43%)

Unknown 0 (0%) 0 (0%) 0 (0%) 0 (0%) Unknown 9 (2%) Unknown 0 (0%)

Figure 2.13

0

10

20

30

40

Per

cent

age

of a

ll pa

tient

s

2006 2007 2008 2009 2010 2011 2012

Year starting RRT

Coronary

Peripheral Vascular

Cerebrovascular

Lung

(Suspected cases included)

Comorbid Conditions at Entry to RRTAustralia

Figure 2.14

0

10

20

30

40

Per

cent

age

of a

ll pa

tient

s

2006 2007 2008 2009 2010 2011 2012

Year starting RRT

Coronary

Peripheral Vascular

CerebrovascularLung

(Suspected cases included)

Comorbid Conditions at Entry to RRTNew Zealand

2-9


Figure 2.15 Figure 2.16


13

41

46

13

39

48

11

41

48

11

42

47

12

42

46

12

43

45

Per

cent

age

of a

ll pa

tient

s

2007 2008 2009 2010 2011 2012

Smoking Status at Entry to RRTAustralia

NeverFormer

Current17

36

47

16

34

50

15

38

47

13

38

49

17

41

42

15

39

46

Per

cent

age

of a

ll pa

tient

s2007 2008 2009 2010 2011 2012

Smoking Status at Entry to RRTNew Zealand

NeverFormer

Current

57

3

40

56

3

40

55

3

42

53

4

43

53

4

43

53

6

41

Per

cent

age

of a

ll pa

tient

s

2007 2008 2009 2010 2011 2012

Diabetes Status at Entry to RRTAustralia

Type 2 DMType 1 DM

Non-DM

53

2

44

49

3

47

47

2

51

44

2

53

51

4

45

43

3

54

Per

cent

age

of a

ll pa

tient

s

2007 2008 2009 2010 2011 2012

Diabetes Status at Entry to RRTNew Zealand

Type 2 DMType 1 DM

Non-DM

SMOKING STATUS AT ENTRY

DIABETES STATUS AT ENTRY

2-10


PRIMARY RENAL DISEASE OF NEW PATIENTS The coding of primary renal disease in ANZDATA has remained unchanged for many years. During that time, a number of new disease entities have emerged, and the understanding of others considerably evolved. To better reflect this, a project is underway to review and modify the categories used to report primary renal disease in future reports. It is likely the introduction of these codes will be staged over several years.

AUSTRALIA

Diabetic nephropathy (36% of all new patients), continued as the most common primary renal disease (Figure 2.19).

Glomerulonephritis (19%) was the next most common primary disease, followed by hypertension (12%), polycystic kidney disease (5%) and reflux nephropathy (3%). IgA + mesangioproliferative GN (29% of all GN) was the most common histologically proven form of glomerulonephritis (Figure 2.20).

Miscellaneous diseases causing end stage renal failure are tabulated in Figure 2.21. A renal biopsy was performed in 73% of patients with glomerulonephritis and 13% of patients with type 2 diabetes (Figure 2.22).

NEW ZEALAND

Diabetic nephropathy (49%) was the most common cause of ESRD followed by glomerulonephritis (20%) and hypertension (11%).

IgA nephropathy and focal sclerosis are the most common forms of GN in New Zealand (causing end-stage kidney disease).

Figure 2.20

Types of Glomerulonephritis 1-Jan-2012 to 31-Dec-2012

Number (% of all GN) Australia New Zealand

Advanced GN (unclassified=end stage) 10 (2%) 3 (3%)

Extra and intra capillary GN (rapidly progressive) 5 (1%) 3 (3%)

Familial GN (including alports) 6 (1%) 2 (2%)

Focal and segmental proliferative GN 17 (3%) 1 (1%)

Focal sclerosing GN (including hyalinosis) 25 (5%) 6 (6%)

GN other (specify) 18 (4%) 4 (4%)

GN with systemic disease (specify) 7 (1%) 0 (0%)

Goodpastures with linear IgG and lung haemorrhage 10 (2%) 0 (0%)

Henoch-schonlein purpura 2 (0%) 0 (0%)

Membranous GN 23 (5%) 5 (5%)

Mesangial proliferative (IgA+) 144 (29%) 18 (17%)

Mesangial proliferative (IgA-) 7 (1%) 2 (2%)

Mesangial proliferative (no if studies) 4 (1%) 1 (1%)

Mesangiocapillary GN (dense deposit disease) 2 (0%) 0 (0%)

Mesangiocapillary GN (double contour) 10 (2%) 3 (3%)

Microscopic polyarteritis 6 (1%) 5 (5%)

Presumed GN (no biopsy) 122 (25%) 23 (22%)

Primary focal sclerosing GN/focal glomerular sclerosis 27 (6%) 20 (19%)

Proliferative GN with linear IgG and no lung haemorrhage 1 (0%) 3 (3%)

S.L.E. 18 (4%) 4 (4%)

Scleroderma 4 (1%) 0 (0%)

Secondary focal sclerosing GN 7 (1%) 0 (0%)

Wegeners granulomatosis 15 (3%) 2 (2%)

Total 490 105

Figure 2.19

Causes of ESRD 2009 - 2012 Number of Patients (% Patients)

Disease 2009 2010 2012

Australia

Glomerulonephritis 591 (24%) 499 (21%) 490 (19%)

Analgesic Nephropathy 42 (2%) 37 (2%) 35 (1%)

Polycystic Kidney Disease 177 (7%) 167 (7%) 132 (5%)

Reflux 80 (3%) 60 (3%) 66 (3%)

Hypertension 346 (14%) 320 (14%) 303 (12%)

Diabetic Nephropathy 782 (32%) 827 (35%) 913 (36%)

Miscellaneous 268 (11%) 290 (12%) 440 (17%)

Uncertain diagnosis 145 (6%) 130 (6%) 155 (6%)

Australia Total 2431 2330 2534

New Zealand

Glomerulonephritis 125 (21%) 111 (22%) 105 (20%)

Analgesic Nephropathy 2 (0%) 2 (0%) 4 (1%)

Polycystic Kidney Disease 34 (6%) 18 (3%) 27 (5%)

Reflux 9 (2%) 8 (2%) 8 (2%)

Hypertension 62 (11%) 58 (11%) 48 (9%)

Diabetic Nephropathy 279 (48%) 260 (50%) 249 (49%)

Miscellaneous 54 (9%) 41 (8%) 57 (11%)

Uncertain diagnosis 19 (3%) 17 (3%) 15 (3%)

NZ Total 584 515 513

2011

566 (23%)

32 (1%)

143 (6%)

56 (2%)

360 (14%)

886 (35%)

316 (13%)

137 (5%)

2496

114 (24%)

5 (1%)

28 (6%)

9 (2%)

51 (11%)

204 (42%)

53 (11%)

21 (4%)

485

2-11


Figure 2.22

0

25

50

75

100

Bio

psy

ra

te (

%)

20032004

20052006

20072008

20092010

20112012

Year

GlomerulonephritisType 2 Diabetes

Biopsy RatesAustralia

0

25

50

75

100

Bio

psy

rate

(%

)

20032004

20052006

20072008

20092010

20112012

Year

GlomerulonephritisType 2 Diabetes

Biopsy RatesNew Zealand

Figure 2.21

Miscellaneous Causes of ESRD 1-Jan-2012 to 31-Dec-2012

Renal Disease Aust (440)

NZ (57)

Renal Disease Aust (440)

NZ (57)

LEAD NEPHROPATHY 1 0 MEDULLARY CYSTIC DISEASE 2 1

INTERSTITIAL NEPHRITIS 32 2 CALCULI 13 1

LOSS OF SINGLE KIDNEY (TRAUMA-SURGERY) 4 0

OXALOSIS 1 0 HAEMOLYTIC URAEMIC SYNDROME 8 1

CYSTINOSIS 1 0 CORTICAL NECROSIS 2 0

LITHIUM TOXICITY 20 2

POST PARTUM NEPHROPATHY 1 1 AMYLOID DISEASE 13 3

SARCOIDOSIS 4 0 PARAPROTEINAEMIA 28 3

CALCINEURIN INHIBITOR TOXICITY 7 3 (INCLUDING MULTIPLE MYELOMA) 2

PYELONEPHRITIS 3 1 LIGHT CHAIN NEPHROPATHY 3

GOUT 2 0 (NON MALIGNANT) 2

RENAL CELL CARCINOMA (GRAWITZ) 13 0

CONGENITAL RENAL HYPOPLASIA AND DYSPLASIA 11 2 TRANSITIONAL CELL CARCINOMA 3

MEGAURETER 2 0 URINARY TRACT

POSTERIOR URETHRAL VALVES 2 2

NEUROPATHIC BLADDER 3 0

SPINA BIFIDA OR MYELOMENINGOCOELE 4 2 REPORTED INCORRECTLY * 156 15

BLADDER NECK OBSTRUCTION 6 0 UNKNOWN/NOT REPORTED 60 12

OTHER LOWER URINARY TRACT ABNORMALITIES 1 0

URETERIC OBSTRUCTIVE NEPHROPATHY 10 0

OBSTRUCTIVE NEPHROPATHY 24 2

* Queries outstanding on 2012 new patient reporting of primary renal disease at time of data lock

(INCL. PROSTATOMEGALY)

(WITH 2ND.REFLUX)

2-12



Stephen McDonald

CHAPTER 3

DEATHS


3-2

DEATHS ANZDATA Registry 2013 Report _____________________________________________________________________________________

INTRODUCTION

Observed survival for non-indigenous patients who started in the period 2003-2012 is shown in Figure 3.1. These data are censored at transplantation (that is, events after the date of first transplantation are not included in anal-yses). Survival after transplantation and survival of indigenous peoples during dialysis is covered in later chapters.

Crude unadjusted death rates for dialysis and transplantation are shown in Figure 3.2 for various groups. This is a different way of looking at the same question. This table includes all episodes of dialysis and transplantation (i.e. analyses are not censored at first transplant date), and deaths are attributed to the modality in use at the time of death. For this table, episodes of treatment include all people treated in 2012, regardless of year of first treatment.

Mortality rates are generally higher with older age, diabetes and coronary artery disease. The comparison between indigenous rates (and some other comparisons) will be subject to several confounders. Comparisons of mortality rates with the general population (stratified by gender) are shown in Figures 3.3 and 3.4.

Figure 3.1

Survival among People who Commenced Dialysis 2003 - 2012 (Non-Indigenous) % (95% CI)

Age at Start Time Point

(Number of Years from dialysis start)

Proportion Surviving Aust (95 % CI)

Proportion Surviving NZ (95 % CI)

0– 24 1 97 (95-98) 96 (90-99)

2 93 (90-95) 93 (85-97)

5 90 (86-93) 83 (64-92)

25—44 1 97 (96-98) 98 (96-99)

2 92 (90-93) 93 (89-96)

5 80 (78-83) 74 (65-81)

45—64 1 92 (91-92) 91 (89-92)

2 85 (84-85) 81 (78-84)

5 61 (59-62) 54 (49-58)

65—74 1 86 (85-87) 85 (82-87)

5 42 (41-44) 34 (30-39)

75—84 1 80 (79-81) 77 (72-81)

2 64 (63-66) 56 (51-61)

5 28 (26-29) 19 (15-24)

85 + 1 70 (66-74) 67 (46-80)

5 20 (15-24) 17 (5-34)

2 74 (72-75) 72 (69-76)

2 51 (47-56) 45 (28-61)

3-3

ANZDATA Registry 2013 Report DEATHS _____________________________________________________________________________________

Figure 3.2

Death Rates During Renal Replacement Therapy All Patients Included who Received Treatment During 2012

Group Dialysis

Mortality Rate (per 100 patient years, 95% CI)

Transplant Mortality Rate

(per 100 patient years, 95% CI)

Overall

Rate Confidence Intervals Rate Confidence Intervals

Per 100 patient years Lower Upper Per 100 patient

years Lower Upper

Australia 12.7 12.2 13.4 1.8 1.6 2.1

New Zealand 14.6 13.2 16.2 1.9 1.3 2.8

AGES (YEARS)

< 25 3.7 2.0 7.0 0.4 0.1 1.5

25—44 4.9 3.9 6.1 0.5 0.3 0.8

45—64 9.3 8.5 10.2 1.4 1.1 1.8

65—84 17.1 16.1 18.2 5.1 4.1 6.2

≥ 85 36.5 31.6 42.1 2.1 5.4 8.6

DIABETES (AT RRT START)

Non-diabetic 11.2 10.6 12.1 1.7 1.4 2.0

Type 1 12.1 9.6 16.8 2.7 1.7 4.4

Type 2 15.5 14.6 16.6 3.1 2.0 4.9

CORONARY ARTERY DISEASE (AT RRT START) No 9.9 9.3 10.6 1.7 1.5 2.0

Yes 19.0 17.8 20.3 3.1 2.0 4.7

INDIGENOUS

Non-Indigenous (Aus) 13.5 12.8 14.3 1.8 1.5 2.1

Non-Indigenous (NZ) 15.7 13.5 18.3 1.8 1.2 2.8

Aboriginal /Torres Strait Islanders 9.0 7.5 10.7 3.2 1.4 7.1

Maori (in Aus) 9.0 4.9 16.8 3.4 0.5 23.8

Maori (in NZ) 16.4 13.8 19.6 2.5 0.9 6.7

Pacific People (in Aus) 6.5 4.1 10.3 1.3 0.2 9.1

Pacific People (in NZ) 10.2 7.9 13.2 2.1 0.5 8.5

.001

.01

.1

.2

.4

.6

20 40 60 80 20 40 60 80

Female Male

Mor

talit

y pe

r ye

ar

Age (years)Stratified by gender

ANZDATA and ABS data for year 2012

vs. general populationMortality among prevalent dialysis patients


.001

.01

.1

.2

.4

.6

20 40 60 80 20 40 60 80

Female Male

Mo

rta

lity

pe

r ye

ar

Age (years)Stratified by gender

ANZDATA and ABS data for year 2012

vs. general populationMortality among prevalent transplant patients

3-4


Figure 3.5

Survival of Dialysis Patients by Age

Age Groups at start of treatment

Median (25th and 75th centiles), years

Australia 0-24 years *

25-44 years * (5.35-*)

45-64 years 6.35 (3.09-*)

65-74 years 4.18 (1.90-7.23)

75-84 years 3 (1.31-5.32)

85+ years 2.03 (0.76-4.02)

New Zealand 0-24 years 9.64 (8.11-*)

25-44 years 7.28 (4.11-*)

45-64 years 5 (2.65-8.41)

65-74 years 3.65 (1.84-5.93)

75-84 years 2.61 (1.08-4.37)

85+ years 1.70 (0.96-3.58)

Figure 3.6

Survival by Age & Comorbidity Amongst Older Age Groups Median (25th and 75th centiles), years

Age Groups Any Vascular

Disease Diabetes Australia New Zealand

65-69 years No No 5.32 (2.04-*) 6.01 (2.67-7.68)

No Yes 3.95 (1.93-8.29) 5.23 (4.20-8.69)

Yes No 4.30 (2.08-7.04) 2.36 (0.87-4.81)

Yes Yes 4.31 (2.05-6.96) 4.03 (1.41-4.27)

70-74 years No No 5.37 (2.03-8.37) 3.40 (3.12-5.37)

No Yes 5.89 (3.23-8.38 ) 3.33 (2.27-4.41)

Yes No 3.46 (0.96-5.81) 2.55 (1.63-4.45)

Yes Yes 3.65 (1.80-5.97) 3.33 (1.78-4.88)

75-79 years No No 5.47 (2.14-8.31) 3.43 (3.43-3.43)

No Yes 5.59 (2.39-*) 3.92 (3.92-4.39)

Yes No 4.00 (1.85-6.35) 1.42 (0.57-2.43)

Yes Yes 3.08 (1.04-5.48) 2.97 (1.49-5.74)

80-84 years No No 3.41 (2.02-6.21) 2.69 (1.65-3.01)

No Yes 4.34 (2.70-6.17) 0.67 (0.67-0.67)

Yes No 2.28(1.02-4.90) 4.10 (1.04-4.10)

Yes Yes 2.37 (1.29-4.55) 2.82 (2.82-2.82)

85-89 years No No 2.25 (0.63-7.79) *

No Yes 2.39 (0.63-*) *

Yes No 2.17 (1.32-3.58) 1.38 (1.38-4.91)

Yes Yes 1.57 (0.36-6.09) *

Another perspective on survival during dialysis is presented in Figures 3.5 and 3.6. Median survival is the time to which 50% of people can expect to survive. Figure 3.5 shows the median survival of people who started dialysis treatment from 1 January 2003, by various categories.

These survival data are censored at the time of transplantation, and include those who started dialysis in the period 2003-2012. In addition to the median, the 25 and 75th centiles are included to give an indication of the range of observed surviv-als. Some figures are not observed - for example if half of a cohort have not yet died it is not possible to observe a median survival; in other groups the small numbers of events mean the median and 25th/75th centiles are the same. These occur-rences are indicated by * in the tables.

The survival amongst younger people are likely to be strongly affected by the selection bias (fitter people will be progres-sively transplanted and not be included in the analysis from that point).

Figure 3.6 shows the survival figures in more detail, categorised by the presence or absence of any vascular comorbidity and diabetes, with a particular focus on older groups.

The evolution of mortality rates over time is shown in Figures 3.7 and 3.8. In Australia, there is steady improvement in most groups over time. For New Zealand, the trends are less clear, in part reflecting the lower precision with smaller numbers.

3-5


Figure 3.7

.1

.11

.12

.13

.14

.15

Mo

rta

lity

rate

pe

r ye

ar

2001- 2003- 2005- 2007- 2009- 2011-Year of dialysis start

(0-1) year

.08

.1

.12

.14

.16

Mo

rta

lity

rate

pe

r ye

ar

2001- 2003- 2005- 2007- 2009- 2011-Year of dialysis start

(1-2) years

.12

.14

.16

.18

Mo

rta

lity

rate

pe

r ye

ar

2001- 2003- 2005- 2007- 2009-Year of dialysis start

(2-3) years

.1

.15

.2

Mo

rta

lity

rate

pe

r ye

ar

2001- 2003- 2005- 2007-Year of dialysis start

(3-5) years

ANZDATA, censored at transplantation

Dialysis mortality rates in Australia

Figure 3.8

.06

.08

.1

.12

.14

.16

Mo

rta

lity

rate

pe

r ye

ar

2001- 2003- 2005- 2007- 2009- 2011-

Year of dialysis start

(0-1) year

.05

.1

.15

.2

Mo

rta

lity

rate

pe

r ye

ar

2001- 2003- 2005- 2007- 2009- 2011-


(1-2) years

.1

.15

.2

.25

.3

Mo

rta

lity

rate

pe

r ye

ar

2001- 2003- 2005- 2007- 2009-


(2-3) years

.1

.15

.2

.25

.3

Mo

rta

lity

rate

pe

r ye

ar

2001- 2003- 2005- 2007-


(3-5) years

ANZDATA, censored at transplantation

Dialysis mortality rates in New Zealand

3-6


This section contains a summary of trends in various areas. The focus on this section is on deaths reported during 2012. The cause of death reported to ANZDATA is not necessarily the same as that reported on the death certificate. In particular, ANZDATA specifically records a range of reasons for “withdrawal from treatment”. Clearly, the actual cause of death in these instances is uraemia, however the key issues presented here are the “cause” of the withdrawal, in many cases this is related to an underlying comorbidity (these figures are explored further on pages 3-8 and 3-9)

For the purposes of Figures 3.9 - 3.11, deaths were attributed to the modality in use at the time of death.

In both Australia and New Zealand, similar trends are seen although there is a larger proportion of deaths coded as “other” from New Zealand (Figure 3.9). A greater proportion of deaths due to cancer is seen among patients with kidney transplants, whereas among dialysis patients deaths to cardiovascular and infective causes predominate.

CAUSE OF DEATHS

Figure 3.9

0

20

40

60

80

100

HD PD Graft HD PD Graft

Australia New Zealand

Cardiovascular Withdrawal Cancer

Infection Other

Per

cent

Graph by country and dialysis modality at time of death

Deaths occurring during 2012

Cause of death

3-7


The distribution of types of death changes with different age groups. Although one might expect the numbers of deaths reported as treatment withdrawals to increase with age, the proportion of deaths reported as related to with-drawal of dialysis is still substantial in a number of the younger age groups (among dialysis patients) (Figure 3.10)

Figure 3.10

020406080

100

020406080

100

0- 45- 65- 75- 0- 45- 65- 75- 0- 45- 65- 75-

0- 45- 65- 75- 0- 45- 65- 75- 0- 45- 65- 75-

Australia, HD Australia, PD Australia, Graft

New Zealand, HD New Zealand, PD New Zealand, Graft

Cardiovascular Withdrawal Cancer

Infection Other

Per

cent

Graph by country and dialysis modality at time of death


Cause of death

Figure 3.11

Modality at Time of Death and Age at Death – 2012

Cause of Death Haemodialysis Peritoneal Dialysis Transplant

0 - 44 45 - 64 65 - 74 ≥75 0 - 44 45 - 64 65 - 74 ≥75 0 - 44 45 - 64 65 - 74 ≥75

Australia

Cardiovascular 19 113 101 147 5 17 13 29 2 14 20 7

Withdrawal 15 67 88 248 2 13 20 34 2 3 7 4

Cancer 2 17 14 34 0 5 1 3 2 25 15 6

Infection 2 28 30 34 0 7 5 13 5 25 15 6

Other 14 73 58 110 7 8 17 27 2 15 11 7

New Zealand

Cardiovascular 11 41 24 14 0 24 16 13 1 4 2 5

Withdrawal 4 14 13 14 1 7 8 10 0 0 0 1

Cancer 1 3 3 0 0 2 3 1 0 5 3 1

Infection 3 8 3 5 1 3 5 1 0 2 1 0

Other 2 27 22 12 1 16 10 9 0 3 1 0

3-8


WITHDRAWAL FROM DIALYSIS

During 2012 there were 503 deaths in Australia and 72 in New Zealand attributed to withdrawal from therapy. The vast ma-jority of these were among patients receiving dialysis therapy. “Psychosocial” reasons were the most commonly cited reason for withdrawal in patients receiving all modalities.

Figure 3.12 gives broad categories and 3.13 detailed breakdown of the causes for withdrawal. However, the coding of these categories is clearly somewhat subjective.

Figure 3.13

Death Due to Withdrawal - 2012 (Modality at Time of Death)

Withdrawal Haemodialysis Peritoneal Dialysis Transplant Total

Australia

Psychosocial 163 26 7 196

Patient refused further 20 4 4 28

Suicide 5 0 1 6

Cardiovascular comorbidity 81 13 0 94

Cerebrovascular comorbidity 43 10 1 54

Peripheral vascular comorbidity 31 2 0 33

Malignancy related withdrawal 63 11 0 77

Withdrawal due to dialysis 12 3 0 15

Total 418 69 16 503

New Zealand

Psychosocial 15 10 0 25

Suicide 0 0 0 0

Cardiovascular comorbidity 5 5 1 11

Cerebrovascular comorbidity 8 6 0 14

Peripheral vascular comorbidity 8 1 0 9

Malignancy related withdrawal 4 1 0 5

Withdrawal due to dialysis 1 1 0 2

Total 45 26 1 72

Patient refused further 4 2 0 6

Figure 3.12

Country at time of Death and Modality at Death Among Those Who Withdrew From Dialysis and Died in 2012

Cause of Death AUSTRALIA NEW ZEALAND

HD PD GRAFT HD PD GRAFT

Cardiovascular 380 64 43 90 53 12

Withdrawal 418 69 16 45 26 1

Cancer 67 9 48 7 6 9

Infection 94 25 24 19 10 3

Other 255 59 35 63 36 4

3-9


Figure 3.14

Dialysis patients who withdrew by age at death time from first RRT-2012

Time from first RRT (years)

AUSTRALIA NEW ZEALAND

0 - 44 45 - 64 65 - 74 0 - 44 45 - 64 65 - 74

0 2 19 16 2 3 3

1 2 15 13 1 3 3

2 7 15 48 2 7 7

5 8 34 38 0 8 8

Total 19 83 115 5 21 21

Total

86

66

166

185

503

≥75

49

36

96

105

286

≥75

1

6

8

10

25

Total

9

13

24

26

72

Figure 3.14 show the breakdown of the dialysis group by age and by time from start of dialysis for those deaths which occurred in 2012. This area within ANZDATA has been previously been examined in some detail (Chan et al Clin J Am Soc Nephrol 2012; 7: 775-781), available at http://cjasn.asnjournals.org/content/7/5/775.full.

Figure 3.15

020406080

100

020406080

100

0- 45- 65- 75- 0- 45- 65- 75- 0- 45- 65- 75-

0- 45- 65- 75- 0- 45- 65- 75- 0- 45- 65- 75-

Australia, HD Australia, PD Australia, Graft

New Zealand, HD New Zealand, PD New Zealand, Graft

0- 1- 2- 5-

Years since RRT start

Per

cent

Graph by country at time of deathTime period from first renal replacement treatment to date of death


Time from RRT start to death

3-10



Nancy Briggs

Kylie Hurst

Stephen McDonald

Philip Clayton

CHAPTER 4

METHOD AND LOCATION OF DIALYSIS


4-2

METHOD AND LOCATION OF DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________

During 20122 there was an increase of 411 (4%) in the total number of prevalent dialysis patients. There were 11,446 patients (507 per million) receiving dialysis treatment at 31st December 2012.

The distribution of these patients across the modalities continues to change (Figures 4.1 and 4.3). The majority (72%) of haemodialysis patients were out of hospital: 11% were dialysing at home and 61% in satellite centres.

Twelve percent of all prevalent dialysis patients were using automated peritoneal dialysis, a further 7% continuous ambulatory peritoneal dialysis, 22% hospital based haemodialysis, 49% satellite haemodialysis and 9% home haemodialysis.

For the first time in several years the proportion of patients receiving peritoneal dialysis (APD and CAPD) increased slightly in 2012, from 18.8 to 19.5%. Automated peritoneal dialysis increased in 2012 to 1374 patients, and continuous ambulatory peritoneal dialysis increased to 853 patients.

The number of patients receiving dialysis treatment rose in all State/Territories in 2012. The number of dialysis patients in relation to the population in each state is shown in Figure 4.2.

Fifty percent of all prevalent dialysis patients were 65 years or older, and 501 patients (4%) were 85 years or older.

Figure 4.2

Prevalence of Dialysis Dependent Patients By State 2008 - 2012 (per Million Population)

2008 2009 2010 2012

Queensland 1885 (441) 1957 (448) 2004 (453) 2085 (461)

New South Wales* 3363 (497) 3434 (501) 3494 (504) 3707 (525)

Aust. Capital Territory** 235 (422) 239 (423) 245 (427) 269 (455)

Victoria 2486 (470) 2531 (469) 2616 (478) 2792 (498)

Tasmania 179 (359) 199 (395) 192 (378) 214 (416)

South Australia 630 (394) 683 (423) 677 (415) 733 (445)

Northern Territory 398 (1801) 417 (1838) 441 (1915) 502 (2159)

Western Australia 994 (456) 1005 (447) 1035 (451) 1144 (475)

Australia 10170 (476) 10465 (481) 10704 (485) 11446 (507)

New Zealand 2106 (493) 2281 (529) 2388 (547) 2469 (557)

* NSW population excludes residents of the Southern Area Health Service

** ACT population includes residents of the Southern Area Health Service

(Medical services in the ACT service the Southern Area Region of NSW)

2011

2012 (450)

3574 (511)

264 (453)

2704 (489)

204 (399)

712 (435)

464 (2006)

1101 (468)

11035 (494)

2389 (542)

Figure 4.1

Method and Location of Dialysis 2008 - 2012

2008 2009 2010 2011 2012

Aust

Peritoneal Dialysis

APD 1271 1313 1279 1283 1374

CAPD 971 889 812 791 853

Total 2242 2202 2091 2074 2227

HD

Hospital 2327 2347 2315 2381 2552

Home 952 978 981 993 1048

Satellite 4649 4938 5317 5587 5619

Total 7928 8263 8613 8961 9219

NZ

Peritoneal Dialysis

APD 288 337 359 350 366

CAPD 475 463 473 442 406

Total 763 800 832 792 772

HD

Hospital 622 690 733 797 837

Home 331 378 425 432 469

Satellite 390 413 398 368 391

Total 1343 1481 1556 1597 1697

Mode of Treatment

AUSTRALIA

ANZDATA Registry 2013 Report METHOD AND LOCATION OF DIALYSIS _____________________________________________________________________________________

4-3

For those <15 years, peritoneal dialysis was used in 73%, compared with 23% for 15-24 years, 25% for 25-34 years, 19% for 65-84 years and 11% for ≥ 85 years.

Relative to State/Territory population, the highest prevalence rate of dialysis patients was in the Northern Territory (2,159 per million), with rates in other States/Territories ranging from 416 per million in Tasmania to 525 per million in New South Wales (Figure 4.2).

The age distribution of Patients is shown in Figure 4.4.

Figure 4.3

050010001500200025003000350040004500500055006000

0500

10001500200025003000350040004500500055006000

2008 2009 2010 2011 2012

Year

SAT HD 5619 (49%)HOSP HD 2552 (22%)CAPD 853 (7%)HOME HD 1048 (9%)

APD 1374 (12%)

Method N (%)

Australia, 2008-2012

Method and Location of Dialysis

Figure 4.4

16 24 150392

924

1685

25042791

2459

501

Number of PatientsTotal=11,446

Age Group

0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

31 December 2012

Prevalent Dialysis Patients (Australia)

11 9 49 121291

550

953

1606

2429

1187

Patients per Million(Overall Rate 507)

Age Group

0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

31 December 2012

Prevalent Dialysis Patients (Australia)

AUSTRALIA

4-4


New Zealand data are shown in Figures 4.1, 4.2, 4.5 and 4.6.

There was an increase of 80 dialysis patients in 2012 (2,389 patients to 2,469), after an increase of only 1 patient for the previous year and 5% in 2010.

There were increases across all age groups between 15-84 in 2012.

Fifty percent of patients were treated with a form of home dialysis (of whom 31% were peritoneal dialysis patients). Numbers treated with automated peritoneal dialysis were similar in 2011 to 2010 (Figure 4.5)

In 2012, for the second year in a row continuous ambulatory peritoneal dialysis decreased.

Together, hospital haemodialysis and satellite dialysis accounted for 50% of patients in 2012, similar to the previous two years. Satellite haemodialysis numbers increased 3% in 2012 (391 patients).

In contrast to Australia a greater percentage of patients were at home. Of those not at home, a greater proportion were in hospital rather than satellite HD.

Figure 4.5

0

100

200

300

400

500

600

700

800

900

0

100

200

300

400

500

600

700

800

900

2008 2009 2010 2011 2012

Year

SATT HD 391 (16%)HOSP HD 837 (34%)CAPD 406 (16%)HOME HD 469 (19%)

APD 366 (15%)

Method N (%)

New Zealand, 2008-2012

Method and Location of Dialysis

Figure 4.6

2 4 63 130238

470

707591

246

18

Number of PatientsTotal=2,469

Age Group

0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

31 December 2012

Prevalent Dialysis Patients (New Zealand)

6 798

226401

760

1411

1720

1282

237

Patients per Million(Overall Rate 557)

Age Group

0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

31 December 2012

Prevalent Dialysis Patients (New Zealand)

NEW ZEALAND


4-5

Home RRT modalities by country The remainder of the chapter explores differences in home-based renal replacement therapies (peritoneal dialysis, home haemodialysis and transplantation). Figures 4.7 and 4.8 shown the distribution of prevalent re-nal replacement modality by country. Home dialysis therapies (HD and PD) are used more frequently in New Zealand, although the prevalence of transplantation is higher in Australia.

11%

5%

42%

41%

20%

12%

32%

35%


PD Home HD

Other HD Graft

Modality at end of 2012

RRT Modality by Country

19%

9%

71%

31%

19%

50%


PD Home HD

Other HD

Modality at end of 2012, dialysis only

Dialysis Modality by Country

Figure 4.7

Figure 4.8

4-6


The variation in renal replacement therapy modality between states at the end of 2012 is shown in Figures 4.9 and 4.10. There is considerable variation in the pattern between states, both in the split of patients treated with kidney transplantation vs dialysis and between the differing modalities of dialysis.

0

20

40

60

80

100

Per

cent

QLD NSW/ACT VIC TAS SA NT WA NZ

at end of 2012

RRT Modality by State

APD CAPD Hospital HDHome HD Satellite HD Graft

Figure 4.9

0

20

40

60

80

100

Per

cent


at end of 2012

Dialysis Modality by State

PD Home HD Other HD

Figure 4.10


4-7

0

2,500

5,000

7,500

10,000

Num

ber

1990

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New Zealand

Prevalent numbers at year's end

PD Home HD Other HD

Figure 4.11

Home Dialysis Over Time

There has been a growing interest in home therapies in recent years; the temporal trends in utilisation of home dialysis therapies are shown in Figure 4.11. For Australia, although there has been some increase in numbers over the last 10 years treated with both home haemodialysis and peritoneal dialysis, this in-crease is much less than the overall increase in number of prevalent patients, hence the proportion treat-ed at home has fallen. For New Zealand, there has been continued growth in home haemodialysis over the last 5-10 years, but it can be seen the proportion of patients treated at home is also falling over time.

The trends in home dialysis modality utilisation between states, and across age groups, are shown in Figures 4.11 - 4.15. There have been different patterns in utilisation of these therapies in different states. Perhaps the most striking example is WA where there has been a large increase in the numbers receiving home HD, whereas the numbers receiving PD treatment have been static. For both countries strong growth is seen in numbers of home HD patients in all age groups over 45 years. In contrast, numbers of people treated with PD are stable or in many cases falling.

4-8


Figure 4.13

0102030

300350400450500

140160180200

0

100

200300

10203040

2030405060

05

1015

1015202530

200300400500

1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010

NT NSW VIC

QLD SA WA

TAS ACT NZ

Fre

quen

cy

Year

Number of Home HD Patients at End of 2012

Figure 4.12

010203040

200400600800

1000

250300350400450

200300400500

50

100

150

50100150200250

20304050

2030405060

200400600800

1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010

NT NSW VIC

QLD SA WA

TAS ACT NZ

Fre

quen

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Year

Number of PD Patients at End of 2012


4-9

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Australia

5

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New Zealand

Number of Home HD PatientsFigure 4.14

50

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Number of PD Patients

Figure 4.15

4-10


Figure 4.17

Home Dialysis ≥65 years By Australian State and Country

Year Dialysis Australia New

Zealand NT NSW/ACT Vic Qld SA WA Tas Total

2008 PD 6 473 166 172 79 102 24 1022 280

Home HD 1 97 44 37 0 4 2 185 58

2009 PD 5 492 162 173 74 102 23 1031 298

Home HD 1 100 43 37 0 5 2 188 66

2010 PD 8 477 164 157 65 98 21 990 332

Home HD 1 102 47 41 3 8 4 206 70

2011 PD 5 461 168 145 60 100 25 964 317

Home HD 1 109 47 47 4 9 4 221 77

2012 PD 6 476 203 163 75 94 22 1039 305

Home HD 2 117 54 60 11 13 6 263 86

Figure 4.16

Home Modality (HD & PD) numbers by State

Current state PD Home HD Other HD Total

NT 411 240 1434 2085

NSW/ACT 950 477 2549 3976

Vic 457 206 2129 2792

Qld 33 15 166 214

SA 141 22 570 733

WA 30 33 439 502

Tas 205 55 884 1144

NZ 772 469 1228 2469

Total 2999 1517 9399 13915

Figure 4.17 shows in more detail the trend in each of the home modalities by state for patients ≥65 years.

Figure 4.16 shows the numbers of patients (of all ages) in each state performing home dialysis modalities, compared with other (satellite and hospital) HD.

Kevan Polkinghorne

Nancy Briggs

Namrata Khanal

Kylie Hurst

Philip Clayton

CHAPTER 5

HAEMODIALYSIS (including Home Haemodialysis)


5-2

HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________

Figure 5.1

Stock and Flow of Haemodialysis Patients 2008 - 2012

2008 2009 2010 2011 2012

Australia

Pa ents new to HD 2155 2078 2042 2184 2130

First dialysis treatment 1794 1725 1728 1848 1788

Previous dialysis (PD) 321 314 279 302 299

Failed transplant 40 39 35 34 43

Transplanted 534 495 546 521 539

Deaths 1197 1220 1151 1242 1214

Never transplanted 1134 1144 1083 1167 1138

Previous transplant 63 76 68 75 76

Transfer to PD 480 428 373 406 418

Pa ents dialysing at 31 December 7928 8263 8613 8961 9219

Pa ents dialysis at home at 31 December 952 978 981 993 1048

% of all home dialysis (HD and PD) pa‐ents

30% 31% 32% 32% 32%

New Zealand

Pa ents new to HD 394 429 402 411 410

First dialysis treatment 320 360 336 319 331

Previous dialysis (PD) 66 59 59 82 70

Failed transplant 8 10 7 10 9

Transplanted 69 61 50 65 45

Deaths 236 208 203 232 223

Never transplanted 219 195 180 222 216

Previous transplant 17 13 23 10 7

Transfer to PD 161 118 166 144 127

Pa ents dialysing at 31 December 1343 1481 1556 1597 1697

Pa ents dialysis at home at 31 December 331 378 425 432 469

% of all home dialysis (HD and PD) pa‐ents

30% 32% 34% 35% 38%

STOCK AND FLOW

NEW ZEALAND The annual stock and flow of HD patients during the period 2008-2012 is shown in Figures 5.1, 5.4 and 5.5.

There were 1,697 patients receiving treatment at 31st December 2012, a continuation of the trend from previous years.

Hospital based HD (49%), satellite HD (23%) and home HD (27%) proportions reflect increases in uptake of hospital based treatments and a decrease in satellite HD patients. Home HD remains unchanged.

New Zealand data are continued on page 4-5.

AUSTRALIA The annual stock and flow of HD patients during the period 2008-2012 is shown in Figures 5.1, 5.2 and 5.3.

There were 9,219 patients receiving HD treatment at 31st December 2012, an increase of 3%; of these 28% were hospital based, 61% were in satellite centres and 11% at home. Home haemodialysis data are presented in detail from page 5.36.

A total of 1,788 patients received HD for the first time during the year, a slight decrease from the previous year.

The proportion of all HD patients in each age group is shown in Figure 5.7. There were 2,484 people ≥ 75 years receiving haemodialysis, including 447 people ≥ 85 years, a rise of 7% from 2011, following a 7% rise for the previous year.

There were 539 transplant operations to people receiving HD treatment, 6% of all HD patients dialysing and 8% of those patients < 65 years.

There were 1,214 deaths in 2012.

5-3

ANZDATA Registry 2013 Report HAEMODIALYSIS _____________________________________________________________________________________

Figure 5.3

Stock and Flow of Haemodialysis Patients Australia 2008 - 2012 Number (%)

Age Groups 2008 2009 2010 2011 2012

New Patients *

00-14 years 13 (1%) 9 (0%) 14 (1%) 15 (1%) 20 (1%)

15-24 years 42 (2%) 45 (2%) 44 (2%) 46 (2%) 44 (2%)

25-34 years 101 (5%) 88 (4%) 76 (4%) 82 (4%) 109 (5%)

35-44 years 173 (8%) 179 (9%) 173 (8%) 198 (9%) 170 (8%)

45-54 years 345 (16%) 313 (15%) 315 (15%) 328 (15%) 359 (17%)

55-64 years 451 (21%) 451 (22%) 443 (22%) 490 (22%) 484 (23%)

65-74 years 541 (25%) 519 (25%) 485 (24%) 533 (24%) 492 (23%)

75-84 years 432 (20%) 416 (20%) 408 (20%) 429 (20%) 388 (18%)

>=85 years 57 (3%) 58 (3%) 84 (4%) 63 (3%) 64 (3%)

Total 2155 (17%) 2078 (16%) 2042 (16%) 2184 (17%) 2130 (17%)

Patients Dialysing

00-14 years 10 (0%) 9 (0%) 10 (0%) 10 (0%) 11 (0%) 15-24 years 88 (1%) 91 (1%) 100 (1%) 112 (1%) 112 (1%) 25-34 years 290 (4%) 292 (4%) 289 (3%) 283 (3%) 295 (3%) 35-44 years 693 (9%) 696 (8%) 697 (8%) 733 (8%) 723 (8%) 45-54 years 1275 (16%) 1315 (16%) 1314 (15%) 1336 (15%) 1352 (15%) 55-64 years 1725 (22%) 1790 (22%) 1871 (22%) 1945 (22%) 2014 (22%) 65-74 years 1896 (24%) 1989 (24%) 2072 (24%) 2141 (24%) 2228 (24%) 75-84 years 1684 (21%) 1771 (21%) 1869 (22%) 1982 (22%) 2037 (22%) >=85 years 267 (3%) 310 (4%) 391 (5%) 419 (5%) 447 (5%)

Total 7928 (16%) 8263 (16%) 8613 (17%) 8961 (18%) 9219 (18%)

Primary Renal Disease *

Glomerulonephritis 464 (22%) 508 (24%) 427 (21%) 477 (22%) 400 (19%) Analgesic Nephropathy 46 (2%) 41 (2%) 38 (2%) 27 (1%) 30 (1%) Hypertension 316 (15%) 280 (13%) 268 (13%) 316 (14%) 224 (11%) Polycystic Disease 125 (6%) 123 (6%) 136 (7%) 125 (6%) 104 (5%) Reflux Nephropathy 59 (3%) 61 (3%) 43 (2%) 51 (2%) 54 (3%) Diabetic Nephropathy 750 (35%) 687 (33%) 742 (36%) 796 (36%) 809 (38%) Miscellaneous 238 (11%) 245 (12%) 274 (13%) 276 (13%) 390 (18%) Uncertain 157 (7%) 133 (6%) 114 (6%) 116 (5%) 119 (6%)

Total 2155 (17%) 2078 (16%) 2042 (16%) 2184 (17%) 2130 (17%)

* New patients receiving first haemodialysis treatment

Figure 5.2

9219 Patients

0

2000

4000

6000

8000

10000

2008 2009 2010 2011 2012

Prevalent patientsNew patients

TransplantsPerm. TransferDeaths

Stock and Flow of Haemodialysis PatientsAustralia 2008-2012

5-4


Figure 5.5

Stock and Flow of Haemodialysis Patients New Zealand 2008 - 2012 Number (%)

Age Groups 2008 2009 2010 2012

New Patients *

00-14 years 5 (1%) 2 (0%) 1 (0%) 5 (1%)

15-24 years 19 (5%) 10 (2%) 12 (3%) 19 (5%)

25-34 years 15 (4%) 24 (6%) 12 (3%) 20 (5%)

35-44 years 34 (9%) 54 (13%) 41 (10%) 38 (9%)

45-54 years 84 (21%) 89 (21%) 99 (25%) 76 (19%)

55-64 years 117 (30%) 103 (24%) 113 (28%) 123 (30%)

65-74 years 89 (23%) 93 (22%) 82 (20%) 94 (23%)

75-84 years 30 (8%) 51 (12%) 39 (10%) 35 (9%)

>=85 years 1 (0%) 3 (1%) 3 (1%) 0 (0%)

Total 394 (3%) 429 (3%) 402 (3%) 410 (3%)

Patients Dialysing

00-14 years 3 (0%) 3 (0%) 4 (0%) 2 (0%)

15-24 years 38 (3%) 41 (3%) 45 (3%) 45 (3%)

25-34 years 76 (6%) 90 (6%) 90 (6%) 98 (6%)

35-44 years 149 (11%) 162 (11%) 165 (11%) 173 (10%)

45-54 years 275 (20%) 309 (21%) 331 (21%) 348 (21%)

55-64 years 373 (28%) 403 (27%) 431 (28%) 481 (28%)

65-74 years 293 (22%) 316 (21%) 323 (21%) 372 (22%)

75-84 years 126 (9%) 146 (10%) 152 (10%) 163 (10%)

>=85 years 10 (1%) 11 (1%) 15 (1%) 15 (1%)

Total 1343 (3%) 1481 (3%) 1556 (3%) 1697 (3%)


Glomerulonephritis 72 (18%) 97 (23%) 89 (22%) 78 (19%)

Analgesic Nephropathy 1 (0%) 1 (0%) 0 (0%) 3 (1%)

Hypertension 30 (8%) 43 (10%) 36 (9%) 42 (10%)

Polycystic Disease 14 (4%) 18 (4%) 14 (3%) 16 (4%)

Reflux Nephropathy 9 (2%) 3 (1%) 6 (1%) 9 (2%)

Diabetic Nephropathy 204 (52%) 212 (49%) 207 (51%) 204 (50%)

Miscellaneous 49 (12%) 41 (10%) 38 (9%) 45 (11%)

Uncertain 15 (4%) 14 (3%) 12 (3%) 13 (3%)

Total 394 (3%) 429 (3%) 402 (3%) 410 (3%)

* New patients receiving first haemodialysis treatment

2011

1 (0%)

14 (3%)

19 (5%)

44 (11%)

83 (20%)

108 (26%)

100 (24%)

38 (9%)

4 (1%)

411 (3%)

1 (0%)

39 (2%)

90 (6%)

173 (11%)

334 (21%)

453 (28%)

341 (21%)

146 (9%)

20 (1%)

1597 (3%)

99 (24%)

2 (0%)

41 (10%)

20 (5%)

8 (2%)

177 (43%)

44 (11%)

20 (5%)

411 (3%)

Figure 5.4

1697 Patients

0

500

1000

1500

2000

2008 2009 2010 2011 2012

Prevalent patientsNew patients

TransplantsPerm. TransferDeaths

Stock and Flow of Haemodialysis PatientsNew Zealand 2008-2012

5-5


Figure 5.6

0.92.1

5.1

8.0

16.9

22.7 23.1

18.2

3.0

Number of Patients = 2130

0

5

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25

Per

cent

00-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 >=85

Age (%) of New Haemodialysis Patients 2012Australia

Figure 5.7

0.11.2

3.2

7.8

14.7

21.8

24.222.1

4.8


0

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Age (%) of Current Haemodialysis Patients31-Dec-2012 Australia

NEW ZEALAND (continued from page 5-2)

There were 410 patients who received HD for the first time in 2012, similar to previous years. Almost eighty one percent (80.7%) were dialysing for the first time, 17% were previously dialysing with peritoneal dialysis and the remaining 2% had failed transplants.

The modal age group for new HD patients was 55-64 years (30%), 11% were <35 years and 31% ≥ 65 years (Figures 5.5 and 5.8). The age distribution of the prevalent HD population was similar (Figure 5.9).

There were 45 HD patients who received transplants in 2012 (65 in 2011). Only one patient ≥ 65 years was transplanted in 2012 compared with four in 2011.

There were 223 deaths in 2012.

Figure 5.8

1.2

4.6 4.9

9.3

18.5

30.0

22.9

8.5


0

10

20

30

Per

cent

00-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 >=85

Age (%) of New Haemodialysis Patients 2012New Zealand

Figure 5.9

0.1

2.7

5.8

10.2

20.5

28.3

21.9

9.6

0.9


0

10

20

30

Per

cent

00-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 >=85

Age (%) of Current Haemodialysis Patients31-Dec-2012 New Zealand

5-6


Figure 5.10

Blood Flow Rates (mls/minute) 2008 - 2012

Country No. Pts

*CVV HD excluded

NR**

Mls/Minute

<200 200-249 250-299 300-349 350-399 >400

Aust

2008 7927 0 3 52 350 1282 4340 1591 309

2009 8255 1 4 47 292 1208 4742 1630 331

2010 8599 3 10 39 296 1226 4986 1721 318

2011 8927 0 20 28 270 1247 5194 1890 278

2012 9219 0 447 53 221 1263 5193 1764 278

NZ

2008 1343 0 0 6 101 426 553 232 25

2009 1481 1 0 4 94 368 680 300 34

2010 1555 0 1 5 96 393 769 259 32

2011 1596 0 2 4 106 332 910 224 18

2012 1697 0 29 8 116 383 871 257 33

Figure 5.11

Blood Flow Rate by Type of Access December 2012

Blood Flow Rate


AVF AVG CVC* NR** AVF AVG CVC NR**

<200 36 (0.5%) 2 (0.3%) 14 (1.1%) 1 (0.2%) 6 (0.5%) 0 (0.0%) 2 (0.5%) 0 (0.0%)

200-249 138 (2.0%) 21 (3.3%) 60 (4.8%) 2 (0.4%) 78 (6.3%) 2 (2.9%) 35 (9.3%) 1 (4.8%)

250-299 837 (12.2%) 101 (15.9%) 311 (24.8%) 14 (3.1%) 199 (16.2%) 22 (31.9%) 156 (41.3%) 6 (28.6%)

300-349 4003 (58.2%) 383 (60.3%) 722 (57.5%) 85 (18.8%) 661 (53.8%) 38 (55.1%) 166 (43.9%) 6 (28.6%)

350-399 1547 (22.5%) 106 (16.7%) 89 (7.1%) 22 (4.9%) 244 (19.9%) 4 (5.8%) 9 (2.4%) 0 (0.0%)

400+ 261 (3.8%) 14 (2.2%) 1 (0.1%) 2 (0.4%) 30 (2.4%) 2 (2.9%) 1 (0.3%) 0 (0.0%)

NR** 54 (0.8%) 8 (1.3%) 59 (4.7%) 326 (72.1%) 11 (0.9%) 1 (1.4%) 9 (2.4%) 8 (38.1%)

Total 6876 635 1256 452 1229 69 378 21

* Number of patients having C.V.V. HD not included. NR** - Not Reported

Figure 5.13

0.3 0.3 0.5

6.2 6.6 7.0

25.3

20.823.0

49.5

57.1

52.2

16.714.1

15.4

2.1 1.1 2.0

0

20

40

60

Per

cent

<200 200-249 250-299 300-349 350-399 >=400

Distribution of Blood Flow RatesPrevalent Haemodialysis

New Zealand

2012 (1668)2011 (1594)2010 (1554)

At 31 Dec

Figure 5.12

0.5 0.3 0.6

3.4 3.0 2.5

14.3 14.0 14.4

58.1 58.3 59.2

20.021.2

20.1

3.7 3.1 3.2

0

20

40

60

Pe

rce

nt

<200 200-249 250-299 300-349 350-399 >=400

Distribution of Blood Flow RatesPrevalent Haemodialysis

Australia

2012 (8772)2011 (8907)2010 (8586)

At 31 Dec

AUSTRALIA Blood flow rates in Australia showed a similar picture as in 2012. The proportion receiving a blood flow rate of 300 mls/minute or higher was 83% in 2012.

Only 3.3% (274 patients) had blood flow rates < 250 mls/minute. Blood flow rates were not reported in 447 patients.

Blood flow rates of 350 mls/minute and higher were less frequent in patients dialysing using central venous catheters than in those using AVFs or AVGs (Figure 5.11).

NEW ZEALAND In December 2012, 70% of patients were prescribed 300 mls/minute or higher.

There were 8.6% using < 250 mls/minute; many of these were receiving long hour HD.

5-7


Figure 5.14

Duration and Number of Sessions Per Week December 2011

Sessions Per

week

Hours of Each Treatment Total

<4 4 4.5 5 5.5 >5.5 Not Reported

Australia

3.1-4.9 321 (4.0) 3177 (39.3) 1868 (23.1) 2358 (29.2) 127 (1.6) 226 (2.8) 6 (0.1) 8083

<=3 41 (7.3) 95 (16.9) 54 (9.6) 117 (20.9) 16 (2.9) 238 (42.4) 0 (0.0) 561

>=5 64 (40.8) 44 (28.0) 0 (0.0) 7 (4.5) 2 (1.3) 39 (24.8) 1 (0.6) 157

Not reported 1 (0.2) 0 (0.0) 2 (0.5) 1 (0.2) 0 (0.0) 1 (0.2) 413 (98.8) 418

Total 427 (4.6) 3316 (36.0) 1924 (20.9) 2483 (26.9) 145 (1.6) 504 (5.5) 420 (4.6) 9219

New Zealand

3.1-4.9 32 (2.2) 452 (31.3) 380 (26.3) 465 (32.2) 41 (2.8) 61 (4.2) 12 (0.8) 1443

<=3 5 (2.4) 39 (18.9) 25 (12.1) 61 (29.6) 10 (4.9) 60 (29.1) 6 (2.9) 206

>=5 6 (28.6) 5 (23.8) 1 (4.8) 4 (19.0) 0 (0.0) 3 (14.3) 2 (9.5) 21

Not reported 0 (0.0) 0 (0.0) 0 (0.0) 3 (11.1) 0 (0.0) 3 (11.1) 21 (77.8) 27

Total 43 (2.5) 496 (29.2) 406 (23.9) 533 (31.4) 51 (3.0) 127 (7.5) 41 (2.4) 1697

* Intermediate durations are rounded up, e.g. 4.25 is included in 4.5

Figure 5.15

92

62

92

62

92

62

89

92

88

112

86

121

0

20

40

60

80

100

Per

cent


2010 2011 2012 2010 2011 2012

Haemodialysis Frequency per WeekDecember 2010-2012

5+

3.1-4.9<=3

Frequency/Week

FREQUENT AND LONG HAEMODIALYSIS (Figures 5.14 - 5.23)

The proportions of those dialysing > 3 times per week in Australia has plateaued, with no change from 2009. In New Zealand the proportion dialysing more than three times per week continues to increase. The proportions dialysing ≥ 4.5 hours per session has slowly increased. The proportion dialysing more than the “standard” 12 hours per week has been steadily increasing.

In 2012, 59% and 70% of HD patients were dialysing ≥ 13.5 hours per week in Australia and New Zealand respectively. Figures 5.16-5.20 show these from several perspectives.

Figure 5.16

5

40

20

28

26

5

38

21

28

25

5

38

22

28

26

3

36

18

33

37

2

31

23

33

37

3

30

25

32

38

0

20

40

60

80

100

Per

cent


2010 2011 2012 2010 2011 2012

Haemodialysis Session Length (Hours)December 2010-2012

>5.55.554.5

4<4

Length (Hours)

Figure 5.17

5

38

19

31

5

5

37

20

32

5

5

36

21

32

6

2

34

19

38

7

2

28

23

39

7

3

27

24

38

8

0

20

40

60

80

100

Per

cent


2010 2011 2012 2010 2011 2012

Haemodialysis Duration (Hours per Week)December 2010-2012

>=2015-19.913.5-14.9

12-13.4<12

Hours/Week

5-8


Figure 5.18

0

.5

1

1.5

2

2.5

3

3.5

20042005

20062007

20082009

20102011

201220042005

20062007

20082009

20102011

2012

Australia New ZealandP

erce

nt

Survey Period

Percentage of PatientsDialysing Five or More Days per Week

Figure 5.19

45

50

55

60

65

70

20042005

20062007

20082009

20102011

201220042005

20062007

20082009

20102011

2012


Per

cent

Survey Period

Percentage of Patients Dialysing 3 Days per WeekDialysing 4.5 Hours or Longer per Session

Figure 5.20

45

50

55

60

65

70

20042005

20062007

20082009

20102011

201220042005

20062007

20082009

20102011

2012


Per

cent

Survey Period

Percentage of PatientsDialysing >12 Hours per Week

5-9


Figure 5.21

Haemodialysis Percentage ≥ 5 Sessions per Week By Australian State and Country

Australia New

Zealand Qld NSW/ACT Vic Tas SA NT WA

2012 58 (3.6%) 25 (0.9%) 46 (2.0%) 3 (1.7%) 11 (1.9%) 3 (0.6%) 11 (1.4%) 21 (1.3%)

2011 61 (3.7%) 24 (0.8%) 50 (2.2%) 2 (1.3%) 7 (1.2%) 3 (0.7%) 18 (2.1%) 24 (1.5%)

2009 41 (2.6%) 28 (1.0%) 40 (1.9%) 2 (1.4%) 7 (1.3%) 0 (0.0%) 10 (1.3%) 28 (1.9%)

2010 52 (3.2%) 25 (0.9%) 48 (2.2%) 3 (2.1%) 8 (1.4%) 5 (1.2%) 15 (1.9%) 28 (1.8%)

Figure 5.22

Haemodialysis Percentage ≥ 4.5 Hours Per Session Three Sessions per Week

By Australian State and Country

Australia New


2012 802 (59.6%) 1886 (73.8%) 956 (45.7%) 107 (67.7%) 132 (24.4%) 351 (77.0%) 217 (28.7%) 940 (66.7%)

2011 843 (58.7%) 1927 (74.3%) 890 (42.5%) 100 (69.4%) 133 (24.1%) 319 (74.9%) 227 (28.5%) 921 (66.2%)

2009 788 (58.6%) 1748 (72.6%) 663 (34.9%) 81 (60.4%) 132 (25.9%) 305 (80.9%) 192 (26.7%) 754 (57.6%)

2010 829 (59.5%) 1859 (72.8%) 757 (37.8%) 79 (61.2%) 138 (26.2%) 301 (77.2%) 201 (27.1%) 828 (60.6%)

Figure 5.23

Haemodialysis Percentage >12 Hours per Week By Australian State and Country

Australia New


2012 983 (61.7%) 2134 (75.1%) 1167 (50.4%) 126 (70.0%) 161 (27.5%) 358 (77.2%) 277 (34.1%) 1157 (70.1%)

2011 1009 (61.4%) 2185 (75.1%) 1087 (47.1%) 112 (70.9%) 160 (26.8%) 328 (75.4%) 287 (33.3%) 1111 (69.7%)

2010 996 (61.4%) 2083 (73.8%) 959 (43.0%) 92 (63.0%) 167 (29.5%) 311 (77.4%) 257 (32.1%) 997 (64.2%)

2009 964 (61.5%) 1990 (73.4%) 873 (41.1%) 92 (62.2%) 161 (29.8%) 308 (80.4%) 238 (30.7%) 905 (61.1%)

Dialysis frequency and session length vary among the Australian jurisdictions. Patients in Queensland and Victoria are more likely to dialyse more frequently, while patients in New South Wales/ACT and the Northern Territory tend to dialyse longer per session on average (Figures 5.21 - 5.23).

5-10


Figure 5.24

Patient Survival - 90 days after HD start Censored for Transplant 2001 - 2012

% [95% Confidence Interval]

No. of Patients

Survival

6 months 1 year 3 years 5 years

Australia

2001‐2003 3467 96 [95, 97] 90 [88, 91] 68 [66, 70] 50 [48, 52]

2004‐2006 4222 96 [95, 97] 89 [88, 90] 68 [67, 70] 50 [48, 51]

2007‐2009 4697 96 [95, 96] 90 [89, 91] 70 [69, 72] 53 [51, 55]

2010‐2012 4450 96 [96, 97] 91 [90, 92] ‐ ‐

New Zealand

2001‐2003 653 97 [95, 98] 92 [90, 94] 72 [68, 76] 54 [50, 59]

2004‐2006 704 97 [95, 98] 91 [89, 93] 71 [67, 75] 51 [47, 55]

2007‐2009 793 96 [94, 97] 91 [89, 93] 71 [68, 75] 53 [47, 58]

2010‐2012 735 98 [96, 99] 94 [91, 95] ‐ ‐

OUTCOMES AMONG HAEMODIALYSIS PATIENTS

In Australia, there has been little change in haemodialysis patient survival over time, after adjusting for age, diabetes status, sex, race and comorbidities.

In New Zealand, recent cohorts have slightly better survival. Unadjusted survivals are shown in Figures 5.24-5.26.

In both countries, diabetes status and age have marked effects on haemodialysis patient survival. (Figures 5.24 - 5.34).

Note: For all tables and graphs the times indicated are from the 90th day and not the first treatment.

Figure 5.25

0.00

0.25

0.50

0.75

1.00

Pat

ient

Sur

viva

l

0 1 2 3 4 5

Years

2001-2003 (3467)2004-2006 (4222)2007-2009 (4697)

2010-2012 (4450)

Patient Survival - Haemodialysis at 90 Days2001 - 2012

Censored for Transplant - Australia

Figure 5.26

0.00

0.25

0.50

0.75

1.00

Pat

ient

Sur

viva

l

0 1 2 3 4 5

Years

2001-2003 (653)2004-2006 (704)2007-2009 (793)

2010-2012 (735)


Censored for Transplant - New Zealand

5-11


Figures 5.27- 5.28

These figures show survival curves for patients treated with haemodialysis at day 90, adjusted to a median age of 63.1 years for Australia and 57.2 years for New Zealand; non-diabetic primary renal disease; caucasoid race; female gender and no comorbid conditions (lung disease, coronary artery disease, peripheral vascular disease or cerebrovascular disease).

Note: x axis scale refers to time after day 90. PRD = Primary renal disease.

Figure 5.32-5.34 show survival stratified by age at the start of treatment.

Figure 5.27

0.00

0.25

0.50

0.75

1.00

Pat

ient

Sur

viva

l

0 1 2 3 4 5

Years

2001-2003 (3467)2004-2006 (4222)2007-2009 (4697)

2010-2012 (4450)

Adjusted for Age, Race, Diabetic PRD, Comorbidity and Gender



Figure 5.28

0.00

0.25

0.50

0.75

1.00

Pat

ient

Sur

viva

l

0 1 2 3 4 5

Years

2001-2003 (653)2004-2006 (704)2007-2009 (793)

2010-2012 (735)

Adjusted for Age, Race, Diabetic PRD, Comorbidity and Gender



5-12


Figure 5.29

Haemodialysis at 90 Days Patient Survival - Diabetic / Non Diabetic

Censored for Transplant 2001 - 2012 % [95% Confidence Interval]

Survival


Australia

Non Diabetic 96 [96, 96] 90 [89, 91] 70 [69, 71] 53 [51, 54]

Diabetic 96 [96, 97] 90 [89, 91] 68 [67, 70] 49 [47, 50]

New Zealand

Non Diabetic 97 [95, 97] 92 [91, 94] 76 [73, 78] 58 [54, 62]

Diabetic 97 [96, 98] 92 [90, 93] 69 [66, 72] 49 [45, 52]

No. of Patients

11228

5616

1501

1387

Figure 5.30

0.00

0.25

0.50

0.75

1.00

Pat

ient

Sur

viva

l

0 1 2 3 4 5

Years

Non diabetic (11228)

Diabetic (5616)



Figure 5.31

0.00

0.25

0.50

0.75

1.00

Pat

ient

Sur

viva

l

0 1 2 3 4 5

Years

Non diabetic (1501)

Diabetic (1387)



5-13


Figure 5.32

Haemodialysis at 90 Days Patient Survival - By Age Group

Censored for Transplant 2001 - 2012 % [95% Confidence Interval]

Age Groups Survival


Australia

<40 years 1720 99 [98, 99] 97 [96, 98] 88 [86, 90] 80 [77, 83]

40‐59 years 5362 98 [97, 98] 94 [94, 95] 81 [80, 82] 68 [66, 69]

60‐74 years 6047 95 [95, 96] 89 [88, 89] 67 [66, 68] 48 [47, 50]

>=75 years 3715 93 [93, 94] 84 [83, 85] 53 [51, 55] 29 [27, 31]

New Zealand

<40 years 396 100 [98, 100] 97 [95, 99] 83 [77, 87] 75 [68, 81]

40‐59 years 1248 97 [96, 98] 95 [93, 96] 80 [77, 82] 63 [59, 67]

60‐74 years 1000 96 [94, 97] 90 [87, 92] 66 [62, 69] 43 [38, 47]

>=75 years 244 95 [91, 97] 82 [76, 87] 48 [41, 56] 22 [14, 30]

No. of Patients

Figure 5.33

0.00

0.25

0.50

0.75

1.00

Pat

ient

Sur

viva

l

0 1 2 3 4 5

Years

<40 (1720)40-59 (5362)60-74 (6047)

>=75 (3715)

Age (years)



Figure 5.34

0.00

0.25

0.50

0.75

1.00

Pat

ient

Sur

viva

l

0 1 2 3 4 5

Years

<40 (396)40-59 (1248)60-74 (1000)

>=75 (244)

Age (years)



5-14


MEMBRANE TYPE AND SURFACE AREAS

AUSTRALIA Figures 5.35 - 5.37.

Usage of low flux polysulfone dialysers was 0.44% in 2012, 0.77% in December 2011, 2.5% in 2010 and 5% in 2008). The use of high flux polysulphone continues to decrease (0.07% in 2012, <1% in 2011, 2010 and 2009, 1.5% in 2008, 7% in both 2007 and 2006, 9% in 2005 and 39% in 2004.

High flux Polysulphone-Helixone decreased to 61% in December 2012 from 63% in 2011, 57% in 2010, 53% in 2009 and 49% in 2008. Similarly high flux Polyamix increased to 22% in 2012 from 33% in the previous years.

99% of patients were receiving dialysis with high flux dialysers in 2012 (99% in 2011, 96% in 2010, 88% in 2009 and 81% in 2008).

NEW ZEALAND Figures 5.35, 5.36 and 5.39.

Low flux polysulphone decreased to 11.2% in December 2012, from 11% and 13% in December 2011 and 2010 respectively.

81% (1349 patients) were reported as receiving dialysis with high flux dialysers in December 2012, an increase from 77% (1223 patients) in 2011 and 62% (924 patients) in 2010.

Figure 5.35

Haemodialyser Membrane Types by Surface Area 31-Dec-2012

Dialyser Membrane Type Flux

Square Metres Total

<1.0 1.0-1.4 1.5-1.7 1.8-1.9 >1.9

Australia Cellulose Triacetate High . . 1 5 21 27

Polyamix High 3 26 358 . 1604 1991

Polyamix Low . 2 16 . 24 42

Polyethersulfone High . . 4 2 97 103

Polynephron High . . . . 105 105

Polysulphone High 1 2 . 2 1 6

Polysulphone Low . . . 10 31 41

Polysulphone‐Helixone High 2 500 . 3194 1911 5607

Purima Mid . . 13 . . 13

Revaclear High . 180 . . . 180

Revaclear Max High . . . 455 . 455

Synphan Low . 3 . . . 3

Total 6 713 392 3668 3794 9219

New Zealand Polyamix High . 1 9 . 68 78

Polysulphone‐Helixone High . 299 . 363 344 1006

Revaclear High . 10 . . . 10

Unreported Unreported . . . . . 30

Total . 314 53 702 598 1697

Polysulphone Low . 3 . 84 103 190

Polyamix Low . 1 44 . 83 128

.

.

.

.

.

.

.

.

.

.

.

.

646

.

.

.

.

.

30

30

Unreported Unreported . . . . . 646 646

Revaclear Max High . . . 255 . . 255

Figure 5.37

0.1

0.1

0.2

0.0

7.2 8.

3

0.2

7.9

4.4

37.6

42.7

0.2

0.1

26.6

20.2

19.0

22.3

0.5

0.4

0.9

1.4

0

10

20

30

40

Per

cent

<1.3 1.3 1.4 1.6 1.7 1.8 1.9 2.1 2.2 2.4 2.5

Haemodialysis Surface AreaAustralia

Dec 2011 (8908)Dec 2012 (8573)

Figure 5.38

0.1 0.2

0.2

0.1

23

.3

18

.6

6.6

3.2

21

.6

42

.1

35

.8

9.1

6.1

20

.6

6.3

6.2

0

10

20

30

40

Per

cent

<1.3 1.3 1.4 1.7 1.8 2.1 2.2 2.4

Haemodialysis Surface AreaNew Zealand

Dec 2011 (1594)Dec 2012 (1667)

Figure 5.36

Number of Patients at end of 2012 by HD Modality

NT NSW/ACT VIC QLD SA WA TAS NZ Total

HAEMODIALYSIS‐PLATE DIALYSERS 0 1 1 2 0 0 0 0 4

HAEMOFILTRATION 0 10 0 2 1 2 0 1 16

HAEMODIAFILTRATION 5 400 53 286 173 172 27 322 1438

Total 468 2869 2316 1613 590 842 180 1674 10552

HAEMODIALYSIS‐HOLLOW FIBRE DIALYSERS

463 2458 2262 1323 416 668 153 1351 9094

5-15


ANAEMIA

In Australia, mean haemoglobin and erythropoietic agent use has gradually reduced. Haemodialysis patients had a higher erythropoietic agent usage despite a similar mean haemoglobin compared with peritoneal dialysis patients (Figures 5.39 - 5.40).

In New Zealand, mean haemoglobin has stabilised. The increase in erythropoietic agent usage seen over 2005-2012 has reached a plateau and begun to fall.

Figure 5.39

110

115

120

Dec 05Dec 06

Dec 07Dec 08

Dec 09Dec 10

Dec 11Dec 12

Dec 05Dec 06

Dec 07Dec 08

Dec 09Dec 10

Dec 11Dec 12


PD HD

Mea

n H

b(g/

L)

Survey Period

Mean Haemoglobin Among Dialysis PatientsBy Survey Period

Figure 5.40

60

70

80

90

100

Dec 05Dec 06

Dec 07Dec 08

Dec 09Dec 10

Dec 11Dec 12

Dec 05Dec 06

Dec 07Dec 08

Dec 09Dec 10

Dec 11Dec 12


PD HD

Per

cent

Survey Period

Use of Erythropoietic AgentsBy Survey Period

5-16


In Australia, among patients dialysing at 31 December 2012, haemoglobin was <110 g/L in 41% and >140g/L in 3% of haemodialysis patients, which is the same as the previous two years.

In New Zealand, the corresponding percentages were 44% and 4% respectively. Figure 5.42 shows the proportion of patients with proven or likely cardiovascular disease reported as a comorbidity to the Registry, achieving the clinical target of haemoglobin ≤ 120 g/L.

HAEMOGLOBIN

Figure 5.41

39

30

21

83

41

30

19

83

41

30

19

73

41

26

21

84

44

25

18

94

44

27

17

84

Pe

rce

nt


Dec 10 Dec 11 Dec 12 Dec 10 Dec 11 Dec 12

Haemoglobin - HaemodialysisDecember 2008-2012

<110 110-119 120-129 130-139 140Hb(g/L)

39

32

29

41

32

27

41

32

27

38

33

29

40

34

26

40

32

27

Per

cent

No CAD CAD


Haemoglobin - HaemodialysisBy Coronary Artery Disease StatusAustralia - December 2008-2012

<110 110-120 120Hb(g/L)

Figure 5.42

43

28

29

46

28

26

45

28

27

39

29

32

42

28

31

44

30

27

Per

cent

No CAD CAD


Haemoglobin - HaemodialysisBy Coronary Artery Disease Status

New Zealand - December 2008-2012

<110 110-120 120Hb(g/L)

5-17


Figures 5.43- 5.46

The first 2 figures show the median haemoglobin (with inter-quartile range) for individual centres, arranged from lowest to highest. Also shown are the proportion of patients in each centre with a haemoglobin of 110-129 g/L.

In Australia, median haemoglobin for each centre ranged from 105.5 to 122 g/L for haemodialysis patients and in New Zealand 105-116 g/L.

The proportion of patients in Australia with a haemoglobin of 110-129 g/L in each centre ranged from 32% to 78% for haemodialysis patients and for New Zealand 34% to 51%. For Figures 5.45 and 5.46 the error bars show the 95% confidence intervals.

HAEMOGLOBIN BY TREATING CENTRE

Figure 5.43

Excludes hospitals with <10 patients90

100

110

120

130

140

Med

ian

Hb

(g/L

)

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70

Caring Hospital

Australia 31 December 2012

Haemoglobin in Haemodialysis Patients

Figure 5.44


100

110

120

130

140

Med

ian

Hb

(g/L

)

0 1 2 3 4 5 6 7 8 9 10

Caring Hospital

New Zealand 31 December 2012

Haemoglobin in Haemodialysis Patients

Figure 5.45


10

20

30

40

50

60

70

80

90

100

Pe

rce

nt

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70

Caring Hospital


% Haemodialysis Patients with Hb 110-129 g/L

Figure 5.46


10

20

30

40

50

60

70

80

90

100

Per

cent

0 1 2 3 4 5 6 7 8 9 10

Caring Hospital


% Haemodialysis Patients with Hb 110-129 g/L

5-18


FERRITIN AND TRANSFERRIN SATURATION

Figures 5.47 - 5.48

In Australia and New Zealand the proportions of haemodialysis patients with ferritin <200 mcg/L and those with ferritin ≥ 500 mcg/L have been relatively stable.

In Australia distributions of transferrin saturation have been unchanged for the past three years, while in New Zealand the proportion with a transferrin saturation <20 has decreased from 38% in December 2011 to 34% in 2012.

Figure 5.47

1012

37

23

19

1111

39

22

17

1111

39

22

16

14

14

34

23

15

18

13

35

19

15

17

15

35

21

12

Per

cent



Ferritin - HaemodialysisDecember 2008-2012

<100 100-199 200-499 500-799 800g/L

Figure 5.48

31

37

19

13

31

37

19

13

31

37

19

12

31

39

18

12

38

38

17

8

34

37

19

10

Per

cent



Transferrin Saturation - HaemodialysisDecember 2008-2012

<20 20-29 30-39 40T/Sat(%)

5-19


FERRITIN BY TREATING CENTRE

Figures 5.49 - 5.52

These figures show the proportions of patients in each centre with ferritin of 200-500 mcg/L and transferrin saturation of >20% respectively, as recommended by the CARI guidelines.

In Australia, the proportions of patients with ferritin within this range in each centre varied widely between 3-72% for haemodialysis patients. Similarly large variations between centres were seen for transferrin saturation, between 30-86%. This large variation probably reflects differences in practices, protocols and patient case-mix among centres.

In New Zealand, the corresponding figures for ferritin were between 23-49% for haemodialysis patients and the corresponding figures for transferrin saturation were between 48-71%. In both countries, significant proportions of patients did not have ferritin and transferrin saturation within the recommended ranges, even in the “best performing” centres.

Figure 5.51


10

20

30

40

50

60

70

80

90

100

Per

cent

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70

Caring Hospital


% Haemodialysis Patients with TSat >20%

Figure 5.52


10

20

30

40

50

60

70

80

90

100

Per

cent

0 1 2 3 4 5 6 7 8 9 10

Caring Hospital


% Haemodialysis Patients with TSat >20%

Figure 5.49


20

30

4050

60

70

8090

100

Per

cent

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70

Caring Hospital


% Haemodialysis Patientswith Ferritin 200-500 g/L

Figure 5.50


20

30

4050

60

70

8090

100

Per

cent

0 1 2 3 4 5 6 7 8 9 10

Caring Hospital


% Haemodialysis Patientswith Ferritin 200-500 g/L

5-20


SERUM CALCIUM

Figure 5.53

In Australia the proportions of patients with serum calcium ≥ 2.4 mmol/L is stable. In New Zealand it has decreased from 40% in December 2011 to 40% in December 2012. The proportion with calcium < 2.2 mmol/L has increased from 35% in December 2010 to 37% and 36% respectively in 2011 and 2012 in Australia.

Figures 5.54 and 5.55 show the proportions of patients at each centre with serum calcium 2.1-2.4 mmol/L, as recommended by the CARI guidelines. NB the values in the guidelines are for corrected total calcium, while those in this report are for uncorrected total calcium.

In Australia, the proportions ranged widely between 39-81% for haemodialysis patients, while in New Zealand the corresponding proportions were 47-72%.

SERUM CALCIUM BY TREATING CENTRE

Figure 5.53

8

27

42

184

9

28

41

184

8

28

42

184

618

37

28

11

617

36

30

12

618

37

27

13

Per

cent



Serum Calcium - HaemodialysisDecember 2008-2012

<2.0 2.0-2.1 2.2-2.3 2.4-2.5 2.6Calcium(mmol/L)

Figure 5.55


20

30

4050

60

70

8090

100

Per

cent

0 1 2 3 4 5 6 7 8 9 10

Caring Hospital


% Haemodialysis Patients withCalcium 2.1-2.4 mmol/L

Figure 5.54


20

30

4050

60

70

8090

100

Per

cent

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70

Caring Hospital


% Haemodialysis Patientswith Calcium 2.1-2.4 mmol/L

5-21


SERUM PHOSPHATE

Figure 5.56

In Australia, the control of serum phosphate has stabilised after a period of steady improvements. In New Zealand as well, the proportion with serum phosphate > 1.8 mmol/L has largely remained stable.

SERUM PHOSPHATE BY TREATING CENTRE

Figures 5.57 - 5.58 show the proportions of patients at each centre with serum phosphate 0.8-1.6 mmol/L, as recommended by the CARI guidelines.

In Australia, the proportions ranged widely between 27-75% for haemodialysis patients and in

New Zealand, the corresponding proportions were 29-54%.

Figure 5.56

38

16

14

32

36

17

13

33

37

17

14

32

23

15

15

47

25

15

13

47

24

13

14

48

Per

cent



Serum Phosphate - HaemodialysisDecember 2008-2012

<1.4 1.4-1.5 1.6-1.7 1.8Phosphate (mmol/L)

Figure 5.57


20

30

4050

60

70

8090

100

Per

cent

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70

Caring Hospital


% Haemodialysis Patients withPhosphate 0.8-1.6 mmol/L

Figure 5.58


20

30

4050

60

70

8090

100

Per

cent

0 1 2 3 4 5 6 7 8 9 10

Caring Hospital


% Haemodialysis Patients withPhosphate 0.8-1.6 mmol/L

5-22


CALCIUM-PHOSPHATE PRODUCT

Figure 5.59

In both Australia and New Zealand, improvements in the calcium-phosphate product seen over the last few years have plateaued.

Overall, the proportion of people with high calcium-phosphate product was substantially higher in New Zealand than Australia.

Figures 5.60 - 5.61 show the proportions of patients at each centre with calcium-phosphate product <4.0 mmol2/L2, as recommended by the CARI guidelines.

In Australia, the proportions ranged widely between 32-87% for haemodialysis patients while in New Zealand, the corresponding proportions were 36-64%.

Figure 5.60


20

30

4050

60

70

8090

100

Per

cent

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70

Caring Hospital


% Haemodialysis Patients withCa X PO4 < 4.0 mmol

2/L

2

Figure 5.59

51

16

128

13

51

15

119

14

51

16

128

13

32

17

15

12

24

33

15

13

12

27

33

14

15

12

26

Pe

rce

nt



Calcium Phosphate Product - HaemodialysisDecember 2008-2012

<3.5 3.5-3.9 4.0-4.4 4.5-4.9 5.0Ca X PO 4 (mmol2/L

2)

Figure 5.61


20

30

4050

60

70

8090

100

Per

cent

0 1 2 3 4 5 6 7 8 9 10

Caring Hospital


% Haemodialysis Patients withCa X PO4 < 4.0 mmol

2/L

2

5-23


UREA REDUCTION RATIO

Figures 5.62-5.64

Distributions of URR values have shown an increase in those in higher URR groups the past three years. About 10% and 27% of patients on haemodialysis three times a week have URR <65% in Australia and New Zealand respectively.

URR is highest in patients dialysing with an AV graft and lowest in those using catheters (Figure 5.63). Of those with URR < 65%, 14% in Australia and 23% in New Zealand had CVC access.

Figure 5.64

Urea Reduction Ratio - Prevalent Patients Three Sessions per Week - December 2012

Hours per Session Urea Reduction Ratio %

< 65 >=65 Total

Australia

<4 hours 37 (13.6%) 236 (86.4%) 273

4 hours 275 (9.6%) 2603 (90.4%) 2878

>4-5 hours 326 (8.6%) 3486 (91.4%) 3812

>5 hours 18 (6.6%) 255 (93.4%) 273

Total 656 (9.1%) 6580 (90.9%) 7236

New Zealand

<4 hours 10 (41.7%) 14 (58.3%) 24

4 hours 111 (28.9%) 273 (71.1%) 384

>4-5 hours 199 (26.7%) 547 (73.3%) 746

>5 hours 15 (19.7%) 61 (80.3%) 76

Total 335 (27.2%) 895 (72.8%) 1230

Figure 5.63

3510

23

28

31

245

18

30

42

912

15

21

20

22

1015

18

19

16

23

612

24

24

18

14

17

21

16

19

12

15P

erc

en

t


AVF AVG CVC AVF AVG CVC

HD Three Sessions per Week - December

Urea Reduction RatioRelated to Type of Access

<60 60-64 65-69 70-74 75-79 80-100URR (%)

Figure 5.62

3511

24

28

28

3511

24

27

30

4611

23

27

30

15

15

19

22

15

14

12

13

19

22

15

19

11

16

18

19

16

20

Per

cent



HD Three Sessions per Week

Urea Reduction Ratio

<60 60-64 65-69 70-74 75-79 80-100URR (%)

5-24


UREA REDUCTION RATIO BY TREATING CENTRE

Figures 5.65 and 5.66 show the median URR in each hospital and Figures 5.67 and 5.68 show the proportions of haemodial-ysis patients dialysing three times per week in each hospital with URR > 70%, the target recommended by the CARI guide-lines.

Median URR values in the respective countries did not vary greatly: 70-88% in Australia and 66-84% in New Zealand. How-ever, the proportions with URR >70% in each unit varied widely, from 44-100% in Australia and 34-90% in New Zealand.

Figure 5.65


60

70

80

90

100

Me

dia

n U

RR

(%)

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70

Caring Hospital


Median URR in Haemodialysis Patients(Three Sessions per Week)

Figure 5.67


20

30

4050

60

70

8090

100

Per

cent

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70

Caring Hospital


% Haemodialysis Patients with URR>70%(Three Sessions per Week)

Figure 5.66


60

70

80

90

100M

edia

n U

RR

(%)

0 1 2 3 4 5 6 7 8

Caring Hospital


Median URR in Haemodialysis Patients(Three Sessions per Week)

Figure 5.68


20

30

4050

60

70

8090

100

Per

cent

0 1 2 3 4 5 6 7 8

Caring Hospital


% Haemodialysis Patients with URR>70%(Three Sessions per Week)

5-25


VASCULAR ACCESS AT FIRST TREATMENT

Figures 5.69 to 5.78

The proportion of patients starting haemodialysis with an AVF has continued to rise in both Australia and New Zealand although the majority of patients still commence with a catheter.

In Australia, tunnelled catheters were more common than non-tunnelled, but the reverse was true in New Zealand. Overall, in New Zealand the use of non-tunnelled catheter has decreased to 35% in 2012 from 45% in 2010.

Female, young (age <25years) patients and those patients who were first seen by nephrologists < 3 months before starting haemodialysis (“late referrals”) were less likely to start with an AVF or AVG.

In both Australian and New Zealand indigenous peoples had similar or decreased rates of AVF or AVG at the commencement of dialysis.

ANZDATA does not collect information about indication for HD catheter usage, hence the reason less than half of non-late referred patients commence with a central venous catheter is not known.

Figure 5.69

37

2

39

22

41

2

38

18

38

2

42

17

43

2

43

12

42

2

39

18

22

1

33

44

29

2

29

41

23

2

30

45

29

1

29

41

33

1

31

35

Pe

rcen

t


2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Vascular Access - Initial RRTHaemodialysis at Initial Modality

AVF AVG Tunnel Catheter Non-Tunnel Catheter

Figure 5.70

162

60

22

39

2

41

18

47

1

36

16

37

2

40

21

29

0

24

47

29

1

33

37

37

1

29

33

28

3

34

34

Pe

rcen

t


<25 25-54 55-74 >=75 <25 25-54 55-74 >=75

Vascular Access - Initial RRTBy Age Group 2012


Figure 5.71

38

2

39

21

43

2

37

18

38

3

43

16

44

2

43

12

42

2

40

17

36

3

39

23

40

3

39

18

38

2

42

18

43

2

43

12

42

1

38

19

Per

cent

Non Diabetic Diabetic

2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Vascular Access - Initial RRTBy Diabetic Status - Australia


Figure 5.72

162

38

44

30

3

27

39

26

1

28

45

29

1

28

43

35

3

29

33

26

0

29

45

28

1

30

41

21

3

31

45

30

1

30

40

32

0

31

37

Per

cent


2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Vascular Access - Initial RRTBy Diabetic Status - New Zealand


5-26



Figure 5.73

33

4

42

21

38

3

41

18

35

3

44

19

40

2

47

11

39

1

41

18

39

1

37

22

43

2

36

19

40

2

42

17

46

1

40

13

43

2

37

18

Per

cent

Female Male

2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Vascular Access - Initial RRTBy Gender - Australia


Figure 5.74

211

33

45

26

5

34

35

193

31

47

26

1

27

47

28

1

34

38

23

1

33

44

31

0

25

44

26

1

30

43

31

0

30

38

36

1

29

34

Per

cent

Female Male

2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Vascular Access - Initial RRTBy Gender - New Zealand


Figure 5.75

47

3

35

15

51

3

32

14

49

3

37

11

53

2

36

9

53

2

33

12

100

50

40

120

55

32

81

58

33

141

64

21

122

54

33

Per

cent

Early Late

2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Vascular Access - Initial RRTBy Referral Time - Australia


Figure 5.76

30

1

34

35

36

3

29

32

30

3

30

37

39

1

26

34

42

2

30

26

31

29

67

40

29

67

00

30

70

30

37

60

30

31

66

Per

cent

Early Late

2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Vascular Access - Initial RRTBy Referral Time - New Zealand


Figure 5.77

44

2

38

16

39

2

38

21

36

2

41

22

38

3

35

25

32

1

30

37

32

0

28

40

Per

cent


Caucasian ATSI Asian Caucasian Maori Pacific People

Vascular Access - Initial RRTBy Racial Origin - 2012


Figure 5.78

25

4

55

16

36

2

41

20

43

2

39

16

45

2

36

18

50

0

34

16

33

0

67

0

173

34

45

34

1

30

35

31

027

42

43

1

30

26

Per

cent


Under

weight

Norm

al

Overw

eight

Obese

Mor

bidly

Obese

Under

weight

Norm

al

Overw

eight

Obese

Mor

bidly

Obe

se

Vascular Access - Initial RRTBy BMI - 2012


5-27



Figure 5.79

Vascular Access at First Treatment Haemodialysis as Initial Modality 1-Jan-2009 to 31-Dec-2012

2009 2010 2011 2012

AVF or AVG CVC AVF or AVG CVC AVF or AVG CVC AVF or AVG CVC

Australia

QLD 152 (41%) 219 (59%) 138 (40%) 208 (60%) 132 (39%) 203 (61%) 141 (45%) 169 (55%)

NSW/ACT 187 (37%) 317 (63%) 201 (37%) 339 (63%) 229 (39%) 358 (61%) 225 (39%) 353 (61%)

Vic 214 (50%) 217 (50%) 201 (45%) 246 (55%) 231 (51%) 225 (49%) 206 (49%) 216 (51%)

Tas 16 (43%) 21 (57%) 19 (61%) 12 (39%) 19 (61%) 12 (39%) 22 (63%) 13 (37%)

SA 89 (61%) 58 (39%) 56 (41%) 82 (59%) 92 (69%) 42 (31%) 70 (49%) 72 (51%)

NT 27 (46%) 32 (54%) 25 (45%) 30 (55%) 38 (49%) 40 (51%) 26 (30%) 60 (70%)

WA 66 (38%) 108 (62%) 55 (32%) 115 (68%) 85 (39%) 131 (61%) 68 (38%) 110 (62%)

New Zealand

111 (31%) 249 (69%) 84 (25%) 251 (75%) 95 (30%) 224 (70%) 113 (34%) 216 (66%)

Figures 5.80 and 5.81 show the proportion of patients in each hospital starting haemodialysis with an AVF/AVG, arranged from the lowest to the highest. In Australia, this ranged widely from 18-77%. The corresponding range in New Zealand was 19-68%. This wide variation reflects differences in practices, protocols, resources and patient case-mix among centres.

Figure 5.81


10

20

30

40

50

60

70

80

90

100

Per

cent

0 1 2 3 4 5 6 7 8

Caring Hospital

% New HD Patients Starting with AVF/AVGNew Zealand 1 Jan 2012 - 31 Dec 2012

Figure 5.80


10

20

30

40

50

60

70

80

90

100

Per

cent

0 5 10 15 20 25 30 35 40 45

Caring Hospital

% New HD Patients Starting with AVF/AVGAustralia 1 Jan 2012 - 31 Dec 2012

5-28


PREVALENT HAEMODIALYSIS ACCESS

Figures 5.82 - 5.90

These show dialysis access among prevalent (rather than incident) patients (those receiving haemodialysis at 31 December 2012).

In both Australia and New Zealand, the proportions of patients dialysing with an AV graft at 31 December 2012 are declining, while those dialysing with an AV fistulas are stable. The proportions dialysing with catheters have increased in New Zealand more than in Australia in 2012.

Female patients in both countries, young (age < 25 years) in Australia or old (age ≥75 years) patients in New Zealand were less likely to be dialysing with an AVF or AVG.

Figure 5.82

78

9

130

79

8

130

78

7

131

73

5

21

1

73

5

21

1

73

4

20

3

Per

cent



Prevalent Haemodialysis Access


Figure 5.83

73

2

23

3

79

6132

79

8131

78

8131

76

217

4

73

3

20

4

75

5

182

64

5

29

3

Pe

rce

nt


<25 25-54 55-74 >=75 <25 25-54 55-74 >=75

Prevalent Haemodialysis AccessBy Age Group - December 2012


5-29



Figure 5.84

79

9120

80

8120

79

8121

76

8

160

78

7140

78

7141

Per

cent



Prevalent Haemodialysis AccessBy Diabetic Status - Australia


Figure 5.85

75

5

200

75

5

191

74

5

184

71

5

23

2

71

5

22

1

73

4

21

2

Per

cent



Prevalent Haemodialysis AccessBy Diabetic Status - New Zealand


Figure 5.86

71

13

160

72

11

160

73

10

151

82

6120

83

6110

82

5111

Per

cent

Female Male


Prevalent Haemodialysis AccessBy Gender - Australia


Figure 5.87

64

8

27

1

67

7

25

1

66

6

25

3

79

3171

77

4

181

78

3162

Per

cent

Female Male


Prevalent Haemodialysis AccessBy Gender - New Zealand


Figure 5.88

69

10

192

78

7141

80

7121

81

7111

82

7101

59

4

30

7

62

5

29

4

75

3202

78

4143

80

4132

Per

cent


Under

weight

Norm

al

Overw

eight

Obese

Mor

bidly

Obese

Under

weight

Norm

al

Overw

eight

Obese

Mor

bidly

Obese

Prevalent Haemodialysis AccessBy BMI - 2012


5-30



In Australia indigenous people were more likely to be dialysing with an AVF. In New Zealand, Maori and Pacific people were more likely to dialyse with an AVF.

Patients on home haemodialysis have the highest rate of AVF use in both Australia and New Zealand.

Figure 5.89

78

8131

82

3131

76

8

151

72

6

19

3

73

5

19

2

77

2192

Per

cent


Caucasian ATSI Asian Caucasian Maori Pacific People

Prevalent Haemodialysis AccessBy Racial Origin - December 2012


Figure 5.90

69

6

23

2

80

8111

92

520

61

4

31

4

82

3142

89

641

Per

cent


Hosp HD Sat HD Home HD Hosp HD Sat HD Home HD

Prevalent Haemodialysis AccessBy Location - December 2012


5-31


Figure 5.91

Prevalent Vascular Access at 31-Dec-2012

Dec 2010 Dec 2011 Dec 2012

AVF or AVG CVC AVF or AVG CVC AVF or AVG CVC

Australia

QLD 1426 (88%) 196 (12%) 1430 (87%) 212 (13%) 1383 (87%) 208 (13%)

NSW/ACT 2391 (85%) 432 (15%) 2492 (86%) 414 (14%) 2418 (85%) 442 (15%)

Vic 1972 (88%) 257 (12%) 2049 (89%) 256 (11%) 2022 (88%) 278 (12%)

Tas 128 (88%) 18 (12%) 134 (85%) 24 (15%) 152 (84%) 29 (16%)

SA 505 (89%) 61 (11%) 555 (93%) 41 (7%) 541 (92%) 46 (8%)

NT 368 (92%) 34 (8%) 393 (90%) 42 (10%) 394 (86%) 65 (14%)

WA 621 (77%) 183 (23%) 674 (78%) 190 (22%) 600 (76%) 187 (24%)

New Zealand

1209 (78%) 346 (22%) 1246 (78%) 347 (22%) 1298 (77%) 378 (23%)

Figures 5.91 - 5.93 show the proportion of haemodialysis patients at each state or hospital dialysing with an AVF/AVG on 31st December, 2012, arranged from the lowest to the highest.

In Australia, the hospital proportions varied widely from 71-100%. The corresponding range in New Zealand was 68-89%. The error bars displayed show the 95% confidence intervals.


Figure 5.92


10

20

30

40

50

60

70

80

90

100

Pe

rce

nt

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70

Caring Hospital

% Prevalent HD Patients Dialysing with AVF/AVGAustralia 31 December 2012

Figure 5.93


10

20

30

40

50

60

70

80

90

100

Per

cent

0 1 2 3 4 5 6 7 8 9 10

Caring Hospital

% Prevalent HD Patients Dialysing with AVF/AVGNew Zealand 31 December 2012

5-32


Figure 5.96

38 39

28

39

3134

31

36 37

54

0

20

40

60

Per

cent

age

Obe

se

QLD NSW ACT VIC TAS SA NT WA AUS NZ

Obesity in Incident Haemodialysis PatientsBy State and Country - 2012

OBESITY AMONG INCIDENT HAEMODIALYSIS PATIENTS

Figures 5.94 - 5.99 show the proportions of incident haemodialysis patients with obesity and morbid obesity. In both Australia and New Zealand obesity rates have been increasing over the last ten years. The proportion of morbidly obese patients starting haemodialysis has doubled from 2003 to 2012 in Australia and increased by approximately 63% in New Zealand.

As might be expected, patients with diabetes are more likely to be obese or morbidly obese compared with those without diabetes (Figures 5.99 - 5.100).

Obesity for these analysis is defined as a BMI>30kg/m². Morbid obesity is defined as ≥35kg/m²

Figure 5.94

2326

29 30 32 34 3235 37 37 39

4447 47 46 45

49 50 5154

0

20

40

60

Per

cent

age

Obe

se


03 04 05 06 07 08 09 10 11 12 03 04 05 06 07 08 09 10 11 12

Obesity in Incident Haemodialysis PatientsBy Year

Figure 5.95

911 12 12

15 16 15 16 1719 19

2123

26 25 24

28

32

28

31

0

10

20

30

Pe

rcen

tage

Mor

bid

ly O

bese


03 04 05 06 07 08 09 10 11 12 03 04 05 06 07 08 09 10 11 12

Morbid Obesity in Incident Haemodialysis PatientsBy Year

5-33


Figure 5.97

19 19

12

21

26

16

13

22

19

31

0

10

20

30

Per

cent

age

Mor

bidl

y O

bese


Morbid Obesity in Incident Haemodialysis PatientsBy State and Country - 2012

10

17

26

1823

39

0

10

20

30

40

Per

cent

age

Mor

bidl

y O

bese


Non-D

iabet

ic

Diabet

es C

o-m

orbid

Diabet

ic Nep

hrop

athy

Non-D

iabet

ic

Diabet

es C

o-m

orbid

Diabet

ic Nep

hrop

athy

Morbid Obesity in Incident Haemodialysis PatientsBy Diabetes - 2012

Figure 5.99

Figure 5.98

26

40

50

39 42

64

0

20

40

60

Pe

rce

nta

ge

Ob

ese


Non-D

iabet

ic

Diabet

es C

o-m

orbid

Diabet

ic Nep

hrop

athy

Non-D

iabet

ic

Diabet

es C

o-m

orbid

Diabet

ic Nep

hrop

athy

Obesity in Incident Haemodialysis PatientsBy Diabetes - 2012

5-34


Figure 5.101

78 8

9 910

1112 12

13

19 1920 20

21 2122

2324

25

0

5

10

15

20

25

Per

cent

age

Mor

bidl

y O

bese


03 04 05 06 07 08 09 10 11 12 03 04 05 06 07 08 09 10 11 12

Morbid Obesity in Prevalent Haemodialysis PatientsBy Year

Figures 5.100 - 5.105 show the proportion of prevalent haemodialysis patients with obesity and morbid obesity. In both Australia and New Zealand prevalent obesity rates have been increasing over the last ten years. In Australia the proportion of morbidly obese patients treated with haemodialysis has nearly doubled from 2003 to 2012.

Patients with diabetes are more likely to be obese or morbidly obese compared to those without diabetes (Figures 5.104 and 5.105).

OBESITY AMONG PREVALENT HAEMODIALYSIS PATIENTS

Figure 5.100

19 20 2123 24

26 2628 29 30

39 40 3941 42 42

44 45 4547

0

10

20

30

40

50

Per

cent

age

Obe

se


03 04 05 06 07 08 09 10 11 12 03 04 05 06 07 08 09 10 11 12

Obesity in Prevalent Haemodialysis PatientsBy Year

5-35


Figure 5.105

3.98.2

118.9

17

26

0

5

10

15

20

25

Pe

rcen

tage

Mo

rbid

ly O

bese


Non-D

iabet

ic

Diabet

es C

o-m

orbid

Diabet

ic Nep

hrop

athy

Non-D

iabet

ic

Diabet

es C

o-m

orbid

Diabet

ic Nep

hrop

athy

Morbid Obesity in Prevalent Haemodialysis PatientsBy Diabetes - 2012

Figure 5.102

30 31

23

29

3432

23

3230

47

0

10

20

30

40

50

Per

cent

age

Obe

se


Obesity in Prevalent Haemodialysis PatientsBy State and Country - 2012

Figure 5.104

17

3037

30

42

58

0

20

40

60

Per

cent

age

Obe

se


Non-D

iabet

ic

Diabet

es C

o-m

orbid

Diabet

ic Nep

hrop

athy

Non-D

iabet

ic

Diabet

es C

o-m

orbid

Diabet

ic Nep

hrop

athy

Obesity in Prevalent Haemodialysis PatientsBy Diabetes - 2012

1314

9

1213

14

8

1413

25

0

5

10

15

20

25

Per

cent

age

Mor

bidl

y O

bese


Morbid Obesity in Prevalent Haemodialysis PatientsBy State and Country - 2012

Figure 5.103

5-36


Home Haemodialysis

The proportion of all prevalent dialysis patients who were using home HD in each State was 12% for New South Wales / ACT, 11.5% Queensland, 7.4% Victoria, 6.6% the Northern Territory, 7% Tasmania, 4.8% Western Australia and 3% for South Australia.

The distribution of patients receiving home haemodialysis by state is shown in Figure 5.106. As can be appreciated, numbers are greatest in New South Wales and in New Zealand, with substantial numbers also in Victoria and Queensland.

These proportions were lower among older people (Figure 5.108).

Considerable further discussion is contained in chapter 4 .

Figure 5.106

240

477

206

15 22 3355

469

0

100

200

300

400

500

Num

ber


at 31-Dec-2012

Home HD Numbers by State

5-37


The distribution of prevalent home dialysis patients by age group is shown in Figure 5.107.

1

21

53

18

7

2

23

51

19

6

2

20

52

23

3

60

20

20

5

45

41

9

9

85

6

15

62

20

4

3

24

55

14

4

0

20

40

60

80

100

Per

cent


at 31-Dec-2012

Home HD by Age Group

<2525-4445-64

65-74>=75

Figure 5.107

Figure 5.108

Proportion (%) of Prevalent Patients aged ≥ 65 years Treated with Home Haemodialysis 2008 - 2012

State 2008 2009 2010 2011 2012

Australia 243 (4.4%) 254 (4.3%) 276 (4.5%) 298 (4.7%) 349 (5.3%)

Queensland 37 (4.1%) 37 (4.0%) 41 (4.2%) 47 (4.9%) 60 (6.1%)

New South Wales/ACT 97 (5.4%) 100 (5.3%) 102 (5.2%) 109 (5.4%) 117 (5.5%)

Victoria 44 (3.5%) 43 (3.3%) 47 (3.4%) 47 (3.2%) 54 (3.5%)

Tasmania 2 (2.7%) 2 (2.4%) 4 (4.3%) 4 (4.0%) 6 (5.4%)

South Australia 0 (0.0%) 0 (0.0%) 3 (0.8%) 4 (1.0%) 11 (2.7%)

Northern Territory 1 (2.0%) 1 (2.3%) 1 (1.9%) 1 (1.7%) 2 (2.9%)

Western Australia 4 (0.9%) 5 (1.1%) 8 (1.7%) 9 (1.8%) 13 (2.5%)

New Zealand 58 (8.2%) 66 (8.6%) 70 (8.5%) 77 (9.3%) 86 (10.1%)

5-38


The trend in numbers treated with home HD for different age groups are illustrated for Australia and New Zealand in the Figure 5.109 and 5.110. The Y axes for individual graphs vary – the absolute numbers in the age groups 25 to 64 years are substantially greater than among older patients. However, there has been strong growth in the older age groups in the last few years.

1520253035

200

220

240

260

300

400

500

600

80100120140160

0

20

40

60

1990 1995 2000 2005 2010

1990 1995 2000 2005 2010 1990 1995 2000 2005 2010

<25 25-44 45-64

65-74 >=75Num

ber

Year

Australia

Home HD Numbers by Age at 31-Dec

Figure 5.109

Figure 5.110

5

10

15

60

80

100

120

50100150

200250

20

40

60

0

5

10

15

1990 1995 2000 2005 2010

1990 1995 2000 2005 2010 1990 1995 2000 2005 2010

<25 25-44 45-64

65-74 >=75Num

ber

Year

New Zealand

Home HD Numbers by Age at 31-Dec

5-39


Technique failure The following three figures explore the concept of technique failure as applied to home haemodialysis. Each treatment episode can end in a variety of ways. Changes to another dialysis modality (either institutional haemodialysis or peritoneal dialysis) are considered a “failure”, as is death. Follow-up is censored at transplantation, or 31 Dec 2012.

Figure 5.112

0.00

0.25

0.50

0.75

1.00

0 2 4 6 8 10

Years

<2525-4445-6465-74

>=75

Age at RRT start

Censored at transplantationAustralia and New Zealand combined

Home Haemodialysis 2002 - 2012

Technique Failure

Figure 5.111

0.00

0.25

0.50

0.75

1.00

0 2 4 6 8 10

Years

AustraliaNew Zealand

Censored at transplantation

Home Haemodialysis 2002 - 2012

Technique Failure

5-40


When death of patient is counted as a censoring event (rather than “failure”), the differences between the age groups become less apparent (Figure 5.113). It can be seen that (among those alive and not transplanted) over 75% of home haemodialysis patients continue in this therapy after 2 years. However, as time passes there is a progressive difference which emerges with higher technique failure rates among the older patients.

Figure 5.113

0.00

0.25

0.50

0.75

1.00

0 2 4 6 8 10

Years

<2525-4445-64

65-74>=75

Age at RRT start

Censored at transplantation and death

Home Haemodialysis 2002 - 2012Australia

Death-censored Technique Failure

0.00

0.25

0.50

0.75

1.00

0 2 4 6 8 10

Years

<2525-4445-64

65-74>=75

Age at RRT start

Censored at transplantation and death

Home Haemodialysis 2002 - 2012New Zealand

Death-censored Technique Failure

Figure 5.114

5-41


Definitions in use CARI guidelines Caring for Australasians with Renal Impairment guidelines

Quotidian HD > 3 sessions/week and/or > 5.5 hours/session

Long Hour HD ≥ 6.5 hours per HD session

High Flux Dialyser Ultrafiltration coefficient (kuf) >20 ml/hr/mmHg as specified by the manufacturer)

AVF Native vein arteriovenous fistula

AVG Synthetic arteriovenous bridge graft

CVC Central venous HD catheter (Includes both tunnelled and non-tunnelled unless otherwise stated)

Obese BMI ≥ 30

Morbid Obesity BMI ≥ 35

5-42



Neil Boudville

Hannah Dent

Stephen McDonald

Kylie Hurst

Philip Clayton

CHAPTER 6

PERITONEAL DIALYSIS


6-2

PERITONEAL DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________

STOCK AND FLOW

AUSTRALIA

Peritoneal dialysis was used to treat 19% of all dialysis patients in 2012 (APD-1374, CAPD-853, total 11446). PD accounted for 44% of all home dialysis, a figure which has remained stable for several years (Figure 6.1). Of the 2,227 patients on peritoneal dialysis at December 2012, 185 (8%)had experienced at least five years of continuous peritoneal dialysis (Figure 6.2).

The proportion of all home dialysis patients on peritoneal dialysis in each State ranged from 12% (Tasmania) to 72% (Western Australia) (Figure 6.1).

The annual stock and flow of patients during the period 2008-2012 is shown in Figures 6.3 and 6.4.

There were 977 new peritoneal dialysis patients in the calendar year 2012; of these 658 patients (67%) started renal replacement therapy with peritoneal dialysis and 319 (33%) had previously been treated with haemodialysis or a transplant (Figure 6.3).

Numbers of new patients over the age of 65 years increased 24%, from 330 to 410 in 2012, following a increase of 8% in 2011 (Figure 6.8). Most age groups increased with the

exception of the 0-14, 15-24 and 45-54 year age groups which decreased slightly.

The proportion of people with diabetic nephropathy has been stable over the last 5 years.

The proportion of patients in each age group treated with peritoneal dialysis ranged from 0% (≥ 85 years) to 28% (55-64 years).

There were 244 deaths in 2012 compared with 278 in 2011.

For more detail see Appendix II at our website (www.anzdata.org.au/v1/report_2013.html).

The prevalence of automated peritoneal dialysis is stable (61%) (Figure 6.10)

There were 210 peritoneal dialysis patients who received a transplant in 2012 compared with 211 in 2011; this was 9% of all patients treated (Figure 6.3).

Permanent transfers to haemodialysis fell in 2012 (to 450 patients (20%) from 477 patients (23%) in 2011. (Figure 6.3).

Figure 6.1

Proportion (%) Peritoneal Dialysis of all

Home Dialysis Patients 2008 - 2012

State 2008 2009 2010 2012 2011

Queensland 52% 50% 48% 41% 44%

New South Wales 44% 42% 40% 42% 40%

Australian Capital Territory 41% 35% 30% 37% 27%

Victoria 47% 44% 42% 42% 40%

Tasmania 36% 35% 32% 12% 24%

South Australia 80% 69% 44% 35% 46%

Northern Territory 37% 33% 44% 38% 38%

Western Australia 82% 78% 73% 72% 73%

Australia 50% 47% 45% 44% 44%

New Zealand 59% 55% 53% 46% 50%

0

100

200

300

Nu

mb

er

of

Patie

nts

0 1 2 3 4 5 6 7 8 9 10

Years on PD

Prevalent PD patients Australia 31 Dec 2012

Time on Peritoneal Dialysis

0

20

40

60

80

Nu

mb

er

of

Patie

nts

0 1 2 3 4 5 6 7 8 9 10

Years on PD

Prevalent PD patients New Zealand 31 Dec 2012

Time on Peritoneal DialysisFigure 6.2a Figure 6.2b

6-3

ANZDATA Registry 2013 Report PERITONEAL DIALYSIS _____________________________________________________________________________________

Figure 6.3

Stock and Flow of Peritoneal Dialysis Patients

2008 - 2012

State 2008 2009 2010 2011 2012

Australia

Patients new to PD 997 894 758 830 977

First Dialysis Treatment 657 589 501 549 658

Previous Dialysis (HD) 329 290 250 273 304

Previous Transplant 11 15 7 8 15

Transplanted 177 160 189 211 210

Deaths 321 334 290 278 244

Never Transplanted 305 322 286 271 237

Previously Transplant 16 12 4 7 7

Transfer to Haemodialysis 526 561 506 477 450

Patients Dialysing (PD) at 31 December 2,242 2,202 2,091 2,074 2,227

New Zealand

Patients new to PD 274 284 275 242 263

First Dialysis Treatment 153 200 163 151 164

Previous Dialysis (HD) 120 82 112 91 95

Previous Transplant 1 2 0 0 4

Transplanted 28 38 45 39 43

Deaths 128 130 117 146 132

Never Transplanted 121 127 111 140 129

Previously Transplant 7 3 6 6 3

Transfer to Haemodialysis 140 134 129 137 138

Patients Dialysing (PD) at 31 December 763 800 832 792 772

These figures are calculated differently to previous years. For example, previous transplant is transplant before PD, and previous HD is HD immediately before PD. Death not include death while on PD and within 30 days of transferring to HD. Transfer to HD is defined

as use of HD > 30 days.

Figure 6.4

2227 Patients

0

500

1000

1500

2000

2500

2008 2009 2010 2011 2012

New Patients

Transplants

Transfer to HD

Deaths

No. dialysing

Stock and Flow of Peritoneal Dialysis PatientsAustralia 2008-2012

Figure 6.5

0

200

400

600

800

1000

2008 2009 2010 2011 2012

New Patients

Transplants

Transfer to HD

Deaths

No. dialysing

Stock and Flow of Peritoneal Dialysis PatientsNew Zealand 2008-2012

6-4


Figure 6.8 Australia

Stock and Flow of Peritoneal Dialysis by Age Groups 2008 - 2012

Age Groups 2008 2009 2010 2011 2012

New Patients *

00-14 years 14 (1%) 25 (3%) 20 (3%) 22 (3%) 20 (2%)

15-24 years 30 (3%) 23 (3%) 16 (2%) 26 (3%) 25 (3%)

25-34 years 53 (5%) 55 (6%) 42 (6%) 42 (5%) 58 (6%)

35-44 years 93 (9%) 76 (9%) 79 (10%) 86 (10%) 115 (12%)

45-54 years 170 (17%) 121 (14%) 130 (17%) 150 (18%) 137 (14%)

55-64 years 217 (22%) 195 (22%) 165 (22%) 174 (21%) 211 (22%)

65-74 years 225 (23%) 225 (25%) 182 (24%) 178 (21%) 237 (24%)

75-84 years 181 (18%) 151 (17%) 113 (15%) 136 (16%) 154 (16%)

>=85 years 14 (1%) 23 (3%) 11 (1%) 16 (2%) 19 (2%)

Total 997 894 758 830 976

Patients Dialysing

00-14 years 28 (1%) 32 (1%) 27 (1%) 25 (1%) 29 (1%)

15-24 years 44 (2%) 52 (2%) 40 (2%) 44 (2%) 35 (2%)

25-34 years 84 (4%) 93 (4%) 91 (4%) 91 (4%) 95 (4%)

35-44 years 177 (8%) 171 (8%) 174 (8%) 178 (9%) 202 (9%)

45-54 years 359 (16%) 327 (15%) 292 (14%) 307 (15%) 325 (15%)

55-64 years 492 (22%) 467 (21%) 456 (22%) 439 (21%) 477 (21%)

65-74 years 556 (25%) 571 (26%) 536 (26%) 511 (25%) 545 (24%)

75-84 years 437 (19%) 420 (19%) 409 (20%) 416 (20%) 453 (20%)

>=85 years 65 (3%) 69 (3%) 66 (3%) 63 (3%) 66 (3%)

Total 2,242 2,202 2,091 2,074 2,227


Glomerulonephritis 260 (26%) 252 (28%) 200 (26%) 223 (27%) 244 (25%)

Analgesic Nephropathy 28 (3%) 13 (1%) 13 (2%) 9 (1%) 10 (1%)

Hypertension 118 (12%) 148 (17%) 97 (13%) 112 (13%) 105 (11%)

Polycystic Disease 67 (7%) 55 (6%) 53 (7%) 45 (5%) 51 (5%)

Reflux Nephropathy 40 (4%) 39 (4%) 22 (3%) 23 (3%) 35 (4%)

Diabetic Nephropathy 328 (33%) 266 (30%) 251 (33%) 272 (33%) 309 (32%)

Miscellaneous 80 (8%) 81 (9%) 84 (11%) 95 (11%) 152 (16%)

Uncertain 76 (8%) 40 (4%) 38 (5%) 51 (6%) 70 (7%)

Total 997 894 758 830 976

* New patients receiving first peritoneal dialysis treatment

Figure 6.6

2.0 2.6

5.9

11.8

14.0

21.6

24.3

15.8

1.9

Number of Patients=976

0

5

10

15

20

25

Pe

rce

nt

0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Australia 2012

Age (%) of New Peritoneal Dialysis Patients

Figure 6.7

1.3 1.6

4.3

9.1

14.6

21.4

24.5

20.3

3.0


0

5

10

15

20

25

Pe

rce

nt

0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Australia 2012

Age (%) of Current Peritoneal Dialysis Patients

6-5


Figure 6.9

73

25 2522 20 19 20 18

11

Number of PD Patients=2227

0

10

20

30

40

50

60

70

80

Pe

rce

nt

0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Australia 2012

PD Patients (%) of All Prevalent Dialysis


Number (per Million) of Prevalent PD Patients, Australia 2008-2012

2008 2009 2010 2011 2012

APD/CAPD

APD 1,271 ( 59.44) 1,313 ( 60.30) 1,279 ( 57.97) 1,283 (57.48) 1,374 (60.82)

CAPD 971 ( 45.41) 889 ( 40.82) 812 ( 36.80) 791 (35.44) 853 (37.76)

Location

Home 2,206 (103.17) 2,178 (100.02) 2,075 ( 94.05) 2,050 (91.84) 2,184 (96.68)

Satellite 0 0 0 1 ( 0.04) 1 ( 0.04)

Hospital 36 ( 1.68) 24 ( 1.10) 16 ( 0.73) 23 ( 1.03) 42 ( 1.86)

Total 2,242 (104.86) 2,202 (101.12) 2,091 (94.78) 2,074 (92.92) 2,227 (98.58)

6-6


NEW ZEALAND

Peritoneal dialysis accounted for 31% of all dialysis patients and 98% of all patients dialysing at home.

A substantially lower proportion of patients used automated PD than in Australia. Forty seven percent of all peritoneal dialysis in 2012 was APD compared with 44% in 2011 and 43% in 2009.

The annual stock and flow of patients during the period 2008 to 2012 is shown in Figures 6.3 and 6.5. Of the 772 patients on peritoneal dialysis at December 2012, 82 (10%) had more than five years continuous treatment (Figure 6.2b).

Primary renal disease of new peritoneal dialysis patients is shown in Figure 6.12, and the age distribution of prevalent peritoneal dialysis patients is shown in Figures 6.14 and 6.15.

The most common primary renal disease of new patients to peritoneal dialysis was diabetic nephropathy (45%), a increase of 1% from 2011, followed by glomerulonephritis (22%) and hypertension (8%).

The proportion of patients in each age group treated with peritoneal dialysis ranged from 67% (0-14 years) and 24% (≥85 years) (Figure 6.11).

There were 132 deaths amongst prevalent peritoneal dialysis patients in 2012 compared with 146 in 2011. (Figure 6.3).

For more detail see Appendix III at our website (www.anzdata.org.au/v1/report_2013.html).

There were 43 patients transplanted in 2012 (39 in 2011).

Figure 6.11

67

2926 26 27

31

3833

24

Number of PD Patients=772

0

10

20

30

40

50

60

70

80

Pe

rce

nt

0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

New Zealand 2012

PD Patients (%) of All Prevalent Dialysis

Figure 6.12

Number (per Million) of Prevalent PD Patients

New Zealand 2008-2012

2008 2009 2010 2011 2012

APD / CAPD

APD 288 (67.47) 337 (78.09) 359 (82.19) 350 (79.45) 366 (82.56)

CAPD 475 (111.27) 463 (107.28) 473 (108.29) 442 (100.34) 406 (91.58)

Location

Home 758 (177.56) 796 (184.44) 828 (189.57) 788 (178.88) 758 (170.99)

Hospital 5 (1.17) 4 (0.93) 4 (0.92) 4 (0.91) 14 (3.16)

Total 763 (178.74) 800 (185.37) 832 (190.48) 792 (179.79) 772 (174.14)

6-7


Figure 6.15 New Zealand

Stock and Flow of Peritoneal Dialysis by Age Groups 2008 - 2012

Age Groups 2008 2009 2010 2011 2012

New Patients *

00-14 years 10 (4%) 3 (1%) 3 (1%) 5 (2%) 6 (2%)

15-24 years 13 (5%) 4 (1%) 8 (3%) 4 (2%) 11 (4%)

25-34 years 11 (4%) 9 (3%) 9 (3%) 12 (5%) 10 (4%)

35-44 years 18 (7%) 28 (10%) 21 (8%) 21 (9%) 25 (10%)

45-54 years 58 (21%) 60 (21%) 41 (15%) 38 (16%) 60 (23%)

55-64 years 77 (28%) 63 (22%) 88 (32%) 72 (30%) 73 (28%)

65-74 years 65 (24%) 83 (29%) 70 (25%) 66 (27%) 63 (24%)

75-84 years 22 (8%) 33 (12%) 35 (13%) 23 (10%) 14 (5%)

>=85 years 0 (0%) 1 (0%) 0 (0%) 1 (0%) 1 (0%)

Total 274 284 275 242 263

Patients Dialysing

00-14 years 13 (2%) 10 (1%) 7 (1%) 9 (1%) 4 (1%)

15-24 years 27 (4%) 26 (3%) 22 (3%) 22 (3%) 17 (2%)

25-34 years 30 (4%) 32 (4%) 29 (3%) 27 (3%) 33 (4%)

35-44 years 58 (8%) 62 (8%) 61 (7%) 58 (7%) 60 (8%)

45-54 years 140 (18%) 149 (19%) 132 (16%) 113 (14%) 122 (16%)

55-64 years 210 (28%) 205 (26%) 240 (29%) 231 (29%) 216 (28%)

65-74 years 183 (24%) 222 (28%) 226 (27%) 223 (28%) 226 (29%)

75-84 years 85 (11%) 83 (10%) 109 (13%) 103 (13%) 88 (11%)

>=85 years 17 (2%) 11 (1%) 6 (1%) 6 (1%) 6 (1%)

Total 763 800 832 792 772


Glomerulonephritis 65 (24%) 57 (20%) 65 (24%) 55 (23%) 59 (22%)

Analgesic Nephropathy 2 (1%) 0 (0%) 3 (1%) 3 (1%) 3 (1%)

Hypertension 35 (13%) 33 (12%) 36 (13%) 29 (12%) 22 (8%)

Polycystic Disease 12 (4%) 18 (6%) 7 (3%) 11 (5%) 13 (5%)


Diabetic Nephropathy 115 (42%) 128 (45%) 134 (49%) 106 (44%) 118 (45%)

Miscellaneous 27 (10%) 31 (11%) 20 (7%) 23 (10%) 32 (12%)

Uncertain 14 (5%) 12 (4%) 7 (3%) 11 (5%) 9 (3%)

Total 274 284 275 242 263

* New patients receiving first peritoneal dialysis treatment

Figure 6.13

2.34.2 3.8

9.5

22.8

27.8

24.0

5.3

0.4


0

5

10

15

20

25

30

Pe

rce

nt

0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

New Zealand 2012

Age (%) of New Peritoneal Dialysis Patients

Figure 6.14

0.52.2

4.3

7.8

15.8

28.029.3

11.4

0.8


0

5

10

15

20

25

30

Pe

rce

nt

0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

New Zealand 2012

Age (%) of Current Peritoneal Dialysis Patients

6-8


PERITONEAL DIALYSIS FLUIDS

At the end of 2012, 34.23% of CAPD and 42.36% of APD patients were receiving Icodextrin in Australia (Figures 6.16 and 6.17). These proportions were lower for CAPD (29.31%) and higher for APD (68.58%) in New Zealand (Figure 6.18). There was also considerable variation between States in Icodextrin usage rates, with the highest rates seen in the South Australia for CAPD and Tasmania for APD (Figure 6.18, 6.19). Low GDP fluids (whether lactate or bicarbonate based fluids) were used infrequently in 2012, consistent with previous years (Figure 6.20 - 6.25). For figures 6.17 to 6.25, percentages are not graphed if fewer than 10 patents.

Figure 6.16

Icodextrin Usage by Modality Type - December 2012

Modality

Type


No Yes NR* Total No Yes NR* Total

546 292 15 853 286 119 1 406 CAPD

n

64.01% 34.23% 1.76% 70.44% 29.31% 0.25% %

APD 768 582 24 1374 113 251 2 366 n

55.90% 42.36% 1.75% 30.87% 68.58% 0.55% %

Total 1314 874 39 2227 399 370 3 772 n

59.00% 39.25% 1.75% 51.68% 47.93% 0.39% %

NR* - Not Reported

Figure 6.17

70

30

66

34

65

35

55

45

55

45

57

43

0

20

40

60

80

100

Pe

rce

nt

CAPD APD


Prevalent Patients December 2010 - 2012Australia

Icodextrin Use by Modality

Yes

No

Icodextrin

Figure 6.18

76

24

73

27

71

29

34

66

31

69

31

69

0

20

40

60

80

100

Pe

rce

nt

CAPD APD


Prevalent Patients December 2010 - 2012New Zealand

Icodextrin Use by Modality

Yes

No

Icodextrin

Figure 6.19

15

85

69

31

70

30

59

41

8

92

72

28

71

29

63

37

68

32

34

66

57

43

56

44

19

81

31

69

0

20

40

60

80

100

Pe

rce

nt

CAPD APD

NT

NS

W/A

CT

VIC

QL

D

SA

WA

TA

S

NZ

NT

NS

W/A

CT

VIC

QL

D

SA

WA

TA

S

NZ

Proportions not presented if <10 patients

Prevalent Patients December 2012

Icodextrin Use by State and New Zealand

Yes

No

Icodextrin

* Percentages are not graphed if fewer than 10 patients. * Percentages are not graphed if fewer than 10 patients.

* Percentages are not graphed if fewer than 10 patients.

6-9



Figure 6.20

Low GDP - Lactate Usage by Modality Type - December 2012

Modality Type



CAPD 775 63 15 853 405 . 1 406 n

90.86% 7.39% 1.76% 99.75% .% 0.25% %

APD 1303 47 24 1374 355 9 2 366 n

94.83% 3.42% 1.75% 96.99% 2.46% 0.55% %

2078 110 39 2227 760 9 3 772 Total

n

93.31% 4.94% 1.75% 98.45% 1.17% 0.39% %

NR* - Not Reported

96

4

98

2

92

8

97

3

97

3

97

3

0

20

40

60

80

100

Pe

rce

nt

CAPD APD



Low GDP - Lactate Use by Modality

Yes

No

Lactate

100

0

100

0

100

0

97

3

97

3

98

2

0

20

40

60

80

100

Pe

rce

nt

CAPD APD



Low GDP - Lactate Use by Modality

Yes

No

Lactate



Figure 6.21

Figure 6.22

6-10


99

1

95

5

98

2

98

2

97

3

98

2

0

20

40

60

80

100

Pe

rce

nt

CAPD APD



Low GDP - Bicarb Use by Modality

Yes

No

Bicarb

Figure 6.24

98

2

99

1

100

0

98

2

99

1

99

1

0

20

40

60

80

100

Pe

rce

nt

CAPD APD



Low GDP - Bicarb Use by Modality

Yes

No

Bicarb

Figure 6.25

Figure 6.23

Low GDP - Bicarb Usage by Modality Type - December 2012

Modality Type



CAPD 822 15 16 853 404 1 1 406 n

96.37% 1.76% 1.88% 99.51% 0.25% 0.25% %

1328 22 24 1374 362 2 2 366 APD

n

96.65% 1.60% 1.75% 98.91% 0.55% 0.55% %

Total 2150 37 40 2227 766 3 3 772 n

96.54% 1.66% 1.80% 99.22% 0.39% 0.39% %

NR* - Not Reported




6-11


Figure 6.26

Peritoneal Dialysis at 90 Days Patient Survival

2001-2012, Censored for Transplant


Year of Starting

No. of Patients

Survival


Australia

2001-2003 1923 96 [95, 97] 89 [87, 90] 64 [61, 66] 42 [40, 45]

2004-2006 1968 96 [95, 97] 91 [90, 92] 67 [65, 70] 49 [46, 51]

2005-2009 2094 97 [97, 98] 92 [91, 93] 71 [69, 73] 52 [49, 55]

2010-2012 1950 97 [97, 98] 94 [93, 95] - -

New Zealand

2001-2003 661 96 [95, 98] 87 [84, 89] 58 [54, 62] 37 [33, 41]

2004-2006 635 97 [96, 98] 91 [88, 93] 67 [63, 70] 44 [40, 48]

2005-2009 622 97 [95, 98] 92 [89, 94] 69 [65, 73] 47 [42, 52]

2010-2012 614 97 [96, 98] 92 [90, 94] - -

OUTCOMES AMONG PERITONEAL DIALYSIS PATIENTS

Patient Survival

On univariate analyses, there has been some slight improvement in PD patient survival in Australia at six months and one, three and five years from 2000.

In New Zealand PD patient survival has improved slightly for each cohort.

(Figures 6.26 - 6.28).

Diabetic PD patients had lower patient survival at later time points in both Australia and New Zealand (Figures 6.29 - 6.31).

As expected PD patient survival is closely related to age (Figures 6.32 -6.34).

Figure 6.27

0.00

0.25

0.50

0.75

1.00

0 1 2 3 4 5

Years

2001-2003 (1923)

2004-2006 (1968)

2007-2009 (2094)

2010-2012 (1950)

Patient Survival - PD at 90th Day of RRT2001 - 2012


Figure 6.28

0.00

0.25

0.50

0.75

1.00

0 1 2 3 4 5

Years

2001-2003 (661)

2004-2006 (635)

2007-2009 (622)

2010-2012 (614)



6-12


Figure 6.29

Peritoneal Dialysis at 90 Days

Patient Survival - Diabetic / Non Diabetic

Censored for Transplant Commenced 2001 - 2012


No. of

Patients

Survival


Australia

Non Diabetic 4730 97 [97, 98] 93 [92, 94] 74 [72, 75] 55 [53, 57]

Diabetic 3203 96 [95, 96] 89 [88, 90] 61 [59, 63] 39 [37, 41]

New Zealand

Non Diabetic 1301 97 [96, 98] 92 [90, 93] 70 [67, 73] 52 [48, 55]

Diabetic 1231 97 [96, 98] 89 [87, 91] 59 [56, 62] 34 [31, 38]

Diabetic patients are those with diabetes as a comorbidity. Previous reports categorised diabetics as those with diabetic nephropathy

Figure 6.30

0.00

0.25

0.50

0.75

1.00

0 1 2 3 4 5

Years

Non-Diabetic (4730)

Diabetic (3203)



Figure 6.31

0.00

0.25

0.50

0.75

1.00

0 1 2 3 4 5

Years

Non-Diabetic (1301)

Diabetic (1231)



6-13


Figure 6.32


Patient Survival - By Age Group

Censored for Transplant 2001 - 2012


Age Groups

Survival No. of

Patients 6 months 1 year 3 years 5 years

Australia

0-14 183 99 [96, 100] 98 [93, 99] 91 [79, 97] 91 [79, 97]

15-34 605 99 [98, 100] 98 [97, 99] 93 [89, 95] 86 [80, 90]

35-54 2041 98 [97, 99] 96 [95, 97] 83 [81, 85] 68 [65, 71]

55-64 1694 98 [97, 98] 93 [92, 95] 72 [69, 74] 54 [51, 57]

65-74 2021 96 [95, 96] 88 [86, 89] 62 [60, 64] 38 [36, 41]

>= 75 1391 94 [92, 95] 84 [82, 86] 49 [46, 52] 27 [24, 29]

New Zealand

0-14 58 96 [87, 99] 96 [87, 99] 89 [71, 96] 89 [71, 96]

15-34 163 99 [96, 100] 97 [93, 99] 91 [83, 95] 82 [72, 89]

35-54 671 97 [96, 98] 94 [92, 96] 72 [68, 76] 52 [47, 57]

55-64 708 98 [96, 99] 92 [90, 94] 66 [62, 70] 45 [41, 50]

65-74 674 97 [95, 98] 86 [83, 89] 57 [53, 61] 31 [27, 35]

>= 75 258 93 [89, 95] 83 [77, 87] 46 [40, 52] 24 [18, 30]

Figure 6.34

0.00

0.25

0.50

0.75

1.00

0 1 2 3 4 5

Years

0-14 (58)

15-34 (163)

35-54 (671)

55-64 (708)

65-74 (674)

75 (258)



Figure 6.33

0.00

0.25

0.50

0.75

1.00

0 1 2 3 4 5

Years

0-14 (183)

15-34 (605)

35-54 (2041)

55-64 (1694)

65-74 (2021)

75 (1391)



6-14


PERITONEAL DIALYSIS TECHNIQUE SURVIVAL

Figure 6.35


Technique Survival - Diabetic / Non Diabetic

Censored for Transplant Commenced 2000- 2011


Survival No. of

Patients 6 months 1 year 3 years 5 years

Australia

Non Diabetic 85 [84, 86] 73 [72, 74] 39 [37, 40] 19 [18, 21] 5130

Diabetic 82 [81, 83] 70 [68, 71] 30 [28, 31] 11 [10, 13] 3501

New Zealand

Non Diabetic 89 [87, 91] 79 [77, 81] 45 [41, 48] 23 [20, 26] 1378

Diabetic 89 [87, 90] 76 [74, 79] 36 [33, 39] 14 [12, 16] 1311

Figure 6.36

0.00

0.25

0.50

0.75

1.00

0 1 2 3 4 5

Years

Non-Diabetic (N=5130)

Diabetic (N=3501)

Technique Survival - PD at 90th Day of RRT2001 - 2012


Figure 6.37

0.00

0.25

0.50

0.75

1.00

0 1 2 3 4 5

Years

Non-Diabetic (N=1378)

Diabetic (N=1311)



Methods

Survivals are calculated using the Kaplan-Meier technique. Patients are followed from the 90th day after first treatment for those on peritoneal dialysis at that time point and not transplanted during those first 90 days.

For patient survival patients are censored at first transplant and at most recent follow up regardless of dialysis modality changes.

For technique survival, failure is defined as a change from peritoneal dialysis to haemodialysis or death.

Figures 6.35-6.41 show Technical survival for patients receiving peritoneal dialysis. In those analysed, patients are censored at the time of transplantation.

6-15


Figure 6.38


Technique Survival - By Age Group

Censored for Transplant 2001 - 2012


Age Groups Survival

No. of Patients 6 months 1 year 3 years 5 years

Australia

2001-2003 2076 83 [81, 85] 70 [68, 72] 32 [30, 34] 13 [12, 15]

2004-2006 2138 84 [82, 85] 71 [69, 73] 33 [31, 35] 15 [13, 17]

2007-2009 2296 84 [82, 85] 72 [70, 74] 36 [34, 38] 18 [16, 20]

2010-2012 2123 85 [84, 87] 75 [73, 77] - -

New Zealand

2001-2003 690 89 [87, 92] 77 [73, 80] 37 [33, 40] 15 [12, 18]

2004-2006 685 88 [85, 90] 76 [73, 79] 41 [37, 45] 19 [16, 22]

2007-2009 665 89 [86, 91] 79 [75, 82] 42 [38, 46] 21 [17, 25]

2010-2012 649 89 [86, 91] 80 [76, 83] - -

Figure 6.39

0.00

0.25

0.50

0.75

1.00

0 1 2 3 4 5

Years

0-14 (N=200)

15-34 (N=656)

35-54 (N=2186)

55-64 (N=1815)

65-74 (N=2213)

75

Age



Figure 6.40

0.00

0.25

0.50

0.75

1.00

0 1 2 3 4 5

Years

0-14 (N=64)

15-34 (N=180)

35-54 (N=708)

55-64 (N=730)

65-74 (N=725)

75 (N=282)

Age



6-16


TECHNIQUE FAILURE

(EXCLUDING DEATH OR TRANSPLANTATION)

Technique failure is analysed here as a change from peritoneal dialysis to haemodialysis and was still treated by haemodialysis at 30 days after the transfer date. In Australia, the most common primary cause of technique failure was due to infective causes (generally acute Peritonitis), rather than a technical cause or patient preference.

This accounted for 30% of transfers during 2012 (Figure 6.41).

Technical failures (primarily dialysate leak) were the second most common cause, followed by dialysis failure (generally inadequate solute clearance).

In New Zealand, the most common primary cause of technique failure was also due to infective causes, which accounted for 34% of transfers during 2011/2012 and technical failure of 22% (Figure 6.45). It is recognised that these are broad categories, and there are likely to be multiple contributors (medical and social) in many individual cases.

Figure 6.41

Causes of Technique Failure 1-Jan-2012 to 31-Dec-2012

Excluding Death, Transplantation, Recovery of Renal Function

Causes of Technique Failure Australia New Zealand

Abdominal Abscess 4 2

Acute Peritonitis 81 26

Diverticulitis 2

Recurrent/Persistent Peritonitis 52 18

Tunnel/Exit Site Infection 10 6

Unspecified Peritoneal Infection 6

Total Infective Causes 155 (30%) 52 (34%)

Catheter Migrated 4

Evacuation Of Hematoma 1

Inadequate Fluid Ultrafiltration 26 16

Inadequate Solute Clearance 48 16

Total Dialysis Failure 79 (15%) 32 (21%)

Abdominal Pain 4 1

Cardiovascular Instability 2 1

Catheter Block 17 2

Catheter Fell Out 1 1

Dialysate Leak 34 5

Hernia 25 5

Hydrothorax 3

Multiple Adhesions 2

Pleural Effusion 4

Sclerosing Peritonitis 1 3

Scrotal Oedema 6 1

Surgery 24 12

Total Technical Failure 121 (23%) 33 (22%)

Geography-Poor Access Dialysis Service 1

Patient Preference 25 6

Unable To Manage Self-Care 36 7

Total Patient Preference 63 (12%) 13 (9%)

Acute Pancreatitis 1

Bronchiectesis 1

Calciphylaxis 2

Failure To Thrive 2

Planned Transfer After Acute PD Start 2 1

Poor Nutrition 2

Total Other 10 (2%) 1 (1%)

Total Not Reported 90 (17%) 20 (13%)

NB Figures relate to 2012 only. Previous data reflected a 2 year period.

6-17


PERITONITIS

Australian median time to first peritonitis was 24 months, with 37% of patients completely free of peritonitis at three years. In New Zealand the time was 21 months (32% of patients free of peritonitis at three years), (Figure 6.42). As noted in previous reports there is a strong association between ethnicity and peritonitis free survival (Figure 6.45).

The median peritonitis-free survival for home automated peritoneal dialysis patients was 32 months in Australia, and 33.7 months in New Zealand. Peritonitis rates in patients treated with APD and CAPD are very similar. This was explored in detail in a recent ANZDATA publication: Lan PG, Johnson DW, McDonald SP, Boudville N, Borlace M, Badve SV, et al. The Association between Peritoneal Dialysis Modality and Peritonitis. Clin J Am Soc Nephrol. 2014 Mar 13.

Figure 6.42

First PD Treatment to First Episode of Peritonitis

By Age at First PD 01-Jan-2008 to 31-Dec-2012

Survival Age Groups

All

00-14 15-34 35-54 55-64 65-74 >=75

Australia (n=101) (n=376) (n=1187) (n=987) (n=1049) (n=756) (n=4456)

3 months 79 [69,85] 88 [84,91] 87 [85,89] 88 [85,90] 90 [88,92] 88 [85,90] 88 [87,89]

6 months 68 [57,76] 80 [76,84] 80 [77,82] 81 [78,83] 84 [81,86] 82 [79,85] 81 [80,82]

9 months 60 [48,70] 73 [68,78] 74 [71,77] 73 [70,76] 77 [74,80] 76 [72,79] 74 [73,76]

1 year 54 [41,65] 68 [62,73] 67 [64,70] 68 [64,71] 72 [69,75] 68 [64,72] 69 [67,70]

2 years 36 [20,52] 50 [42,57] 50 [46,54] 47 [43,51] 54 [50,58] 50 [45,55] 50 [48,52]

3 years 24 [6,47] 35 [26,44] 37 [32,42] 35 [30,40] 38 [33,43] 38 [33,44] 37 [34,39]

New Zealand (n=27) (n=93) (n=379) (n=378) (n=350) (n=111) (n=1338)

3 months 80 [58,91] 92 [84,96] 89 [86,92] 87 [83,90] 85 [81,89] 86 [77,91] 87 [85,89]

6 months 52 [29,70] 83 [73,89] 78 [74,82] 78 [74,82] 77 [72,81] 80 [71,87] 78 [75,80]

9 months 52 [29,70] 72 [60,81] 71 [66,76] 72 [66,76] 70 [65,75] 74 [64,82] 71 [68,73]

1 year 45 [23,65] 68 [56,78] 62 [56,67] 64 [58,69] 63 [57,68] 67 [56,76] 63 [60,66]

2 years 45 [23,65] 40 [24,55] 44 [38,50] 48 [42,55] 44 [37,50] 51 [38,62] 45 [42,49]

3 years - 25 [9,45] 29 [22,37] 38 [30,45] 28 [21,36] 41 [28,55] 32 [28,36]

% Survival [95% Confidence Interval]

Figure 6.43

0.00

0.25

0.50

0.75

1.00

0m 3m 6m 9m 12m/1yr 15m 18m 21m 2yr

Analysis Time

00-14 (101)

15-34 (376)

35-54 (1187)

55-64 (987)

65-74 (1049)

75 (756)

First PD Treatment to First PeritonitisRelated to Age at First PD

2008- 2012 Australia

Figure 6.44

0.00

0.25

0.50

0.75

1.00

0m 3m 6m 9m 12m/1yr 15m 18m 21m 2yr

Analysis Time

00-14 (27)

15-34 (93)

35-54 (379)

55-64 (378)

65-74 (350)

75 (111)

First PD Treatment to First PeritonitisRelated to Age at First PD2008 - 2012 New Zealand

6-18


0.00

0.25

0.50

0.75

1.00

0m 3m 6m 9m 12m/1yr 15m 18m 21m 2yr

Analysis Time

Asian 35-54 (165)

Caucasian 35-54 (776)

Indigenous 35-54 (222)

Asian 55-64 (138)



First PD Treatment to First PeritonitisRelated to Race and Age at First PD

2008 - 2012 Australia

Figure 6.45

0.00

0.25

0.50

0.75

1.00

0m 3m 6m 9m 12m/1yr 15m 18m 21m 2yr

Analysis Time

Asian 35-54 (145)



Asian 55-64 (90)





Figure 6.46

0.00

0.25

0.50

0.75

1.00

0m 3m 6m 9m 12m/1yr 15m 18m 21m 2yr

Analysis Time

Asian 35-54 (33)



Asian 55-64 (45)




2008 - 2012 New Zealand

0.00

0.25

0.50

0.75

1.00

0m 3m 6m 9m 12m/1yr 15m 18m 21m 2yr

Analysis Time

Asian 35-54 (28)



Asian 55-64 (21)





6-19


Figure 6.47

First Home APD Treatment to First Episode of Peritonitis

By Age at Entry 01-Jan-2008 to 31-Dec-2012

Survival Age Groups

All 00-14 15-34 35-54 55-64 65-74 >=75

Australia (n=97) (n=297) (n=860) (n=651) (n=689) (n=474) (n=3068)

3 months 83 [73, 89] 90 [86, 93] 90 [88, 92] 91 [88, 93] 93 [90, 94] 92 [89, 94] 91 [90, 92]

6 months 74 [63, 82] 84 [79, 88] 84 [82, 87] 85 [82, 88] 87 [84, 89] 88 [84, 90] 85 [84, 86]

9 months 69 [57, 78] 78 [72, 83] 79 [76, 82] 80 [76, 83] 81 [78, 84] 78 [74, 82] 79 [77, 81]

1 year 64 [51, 75] 72 [65, 78] 73 [69, 76] 75 [71, 79] 78 [74, 81] 75 [70, 79] 74 [72, 76]

2 years 44 [25, 62] 53 [43, 62] 59 [54, 64] 57 [52, 63] 61 [55, 66] 58 [51, 64] 58 [55, 60]

3 years 44 [25, 62] 37 [26, 48] 43 [37, 50] 53 [47, 59] 48 [41, 54] 46 [38, 55] 47 [43, 50]

New Zealand (n=26) (n=71) (n=259) (n=203) (n=173) (n=48) (n=780)

3 months 88 [67, 96] 88 [77, 94] 89 [84, 92] 95 [91, 97] 92 [86, 95] 98 [85, 100] 92 [89, 93]

6 months 59 [36, 76] 84 [73, 91] 83 [78, 87] 89 [83, 93] 79 [71, 85] 95 [82, 99] 84 [81, 86]

9 months 52 [29, 71] 68 [54, 79] 78 [72, 83] 83 [76, 88] 73 [64, 80] 81 [64, 90] 77 [73, 80]

1 year 52 [29, 71] 66 [51, 77] 72 [65, 78] 75 [67, 81] 68 [59, 75] 71 [53, 84] 71 [67, 74]

2 years 52 [29, 71] 41 [24, 57] 61 [52, 68] 63 [54, 71] 56 [45, 65] 37 [15, 59] 57 [52, 62]

3 years 52 [29, 71] 34 [17, 52] 49 [37, 61] 56 [45, 66] 47 [34, 58] - 48 [42, 54]

% Survival [95% Confidence Interval]

0.00

0.25

0.50

0.75

1.00

0m 3m 6m 9m 12m/1yr 15m 18m 21m 2yr

Analysis Time

00-14 (97)

15-34 (297)

35-54 (860)

55-64 (651)

65-74 (689)

75 (474)

First Home APD Treatment to First PeritonitisRelated to Age at First Home APD


0.00

0.25

0.50

0.75

1.00

0m 3m 6m 9m 12m/1yr 15m 18m 21m 2yr

Analysis Time

00-14 (26)

15-34 (71)

35-54 (259)

55-64 (203)

65-74 (173)

75 (48)

First Home APD Treatment to First PeritonitisRelated to Age at First Home APD


Figure 6.48

6-20


AUSTRALIAN PERITONITIS REGISTRY

1-OCT-2003 TO 31-DEC-2012

This section contains details of the organism and treatment for episodes of peritonitis within Australia collected by ANZDATA. A more detailed collection of data about peritonitis was started in late 2003. Similar information for patients in New Zealand is collected separately by the New Zealand Peritonitis Registry (reported separately).

During 2012, the number of episodes of peritonitis has followed a continuing trend downwards, similar to previous years (shown in Figure 6.49). This is reflected in the overall rates per person-year (figure 6.50). Figure 6.51 shows the rates for each state of Australia. Although the absolute rates vary between states, the overall trend towards lower rates can be seen in most states.

Figure 6.51

Figure 6.50

0.63

0.580.57

0.60

0.62

0.58

0.53

0.43

0.38

24

20

18

Patient-

month

s p

er

epis

ode

0.50

0.60

0.70

Epis

odes p

er

patient-

year

2003/4 2005 2006 2007 2008 2009 2010 2011 2012

Number of Episodes per Patient Year andPatient Months per Episode 2004 – 2012

24

60

12

24

60

12

0.20

0.50

1.00

0.20

0.50

1.00

20

03

/420

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

03

/420

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

03

/420

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

03

/420

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

NT NSW/ACT Vic Qld

SA WA Tas

Epis

od

es p

er

patie

nt-

ye

ar

Graphs by Current state

Number of Episodes per Patient Year andPatient Months per Episode 2004 – 2012

Figure 6.49

Number of Peritonitis Episodes

Year Number

2003 (from Oct 250

2004 1,196

2005 1,072

2006 1,116

2007 1,254

2008 1,369

2009 1,345

2010 1,138

2011 927

2012 893

Total 9,647

6-21


There remains quite widespread variation in the major organisms reported between the different states in Australia (Figure 6.53). We do not collect data about variation in prophylaxis, patient selection processes, PD training or other factors that might account for part or all of this variation.

There has been a gradual trend over this time towards a lower proportion of episodes attributable to gram negative organisms and non-MRSA S. aureus, with a decrease in 2012 of culture negative episodes (Figure 6.52). The Registry does not collect data on use of prior antibiotics or laboratory techniques that might influence the rate of culture negative peritonitis.

Figure 6.53

0

20

40

60

80

100

Pe

rce

nt

NT

NS

W/A

CT

Vic

Qld

SA

WA

Tas

Episodes during 2012

Peritonitis in Australia

Culture negative

Coag neg Staph

MRSA

Staph aureus, non MRSA

Other Gram Pos

Gram negative org

Anaerobes

Fungi

Mycobacteria

Other

No culture taken

0

.2

.4

.6

.8

1

Pro

po

rtio

n

2003

/04

2005

2006

2007

2008

2009

2010

2011

2012

Distribution of Organisms Causing Peritonitis

Culture Negative

Coag neg Staph

MRSA

Staph aureus, nonMRSA

other Gram Pos

Gram negative org

Anaerobes

Fungi

Mycobacteria

Other

Figure 6.52

6-22


ANTIBIOTIC TREATMENT

The proportion of episodes which were treated with an aminoglycoside-containing initial regimen has increased slightly over the period 2006-2009 but declined in 2010-2012. Similarly, the proportion treated with a regimen containing vancomycin is slowly increasing, but declined in 2010 and 2012 (Figure 6.54).

Among episodes of peritonitis treated during 2012, the proportion of those who received vancomycin in the initial or second antibiotic regimen is shown in Figure 6.55.

Figure 6.55

17%

32%

11%

40%

No No No Yes

Yes No Yes Yes

Vanc / gent

First regimen

40%

18%

37%

6%

No No No Yes

Yes No Yes Yes

Vanc / gent

Second regimen

49%

16%

30%

4%

No No No Yes

Yes No Yes Yes

Vanc / gent

Third regimen

0

.2

.4

.6

.8

Pro

po

rtio

n o

f in

itia

l a

ntib

iotic r

eg

ime

ns

2003/42005 2006 2007 2008 2009 2010 2011 2012

Vancomycin

Aminoglycoside

Initial antibiotic regimen

Figure 6.54

6-23


OUTCOMES

There is a strong relationship between the type of organism and the proportion of transfer to permanent haemodialysis. After fungal, mycobacterial or gram negative peritonitis, there is a considerably higher proportion of permanent transfers to HD than with other, more common, causes of peritonitis.

RATES OF PERITONITIS ACROSS INDIVIDUAL UNITS

Figure 6.57 shows the peritonitis rates for all units in Australia over the period 1st October, 2003 to 31st December 2012. Only units who averaged at least ten patient-years of peritonitis treatment per year over that period are included. There is substantial variation in the rates between units; this has been a pattern seen for a number of years.

Figure 6.56

Figure 6.57

24

12

6

4

Pa

tie

nt-

mo

nth

s p

er

ep

iso

de

.5

1

1.5

2

2.5

3

Ep

iso

de

s p

er

pa

tie

nt-

ye

ar

Confidence intervals not shown where upper limit >3Units with <10 person-years PD over 2003-12 not shown

All peritonitis episodes 2003-12

Peritonitis rates by treating unit

158

173

16

97

134

161

1

20

2

30

2

Culture negative

Coag neg Staph

MRSA

Staph aureus, non MRSA

Other Gram Pos

Gram negative org

Anaerobes

Fungi

Mycobacteria

Other

No culture taken

0 .2 .4 .6 .8 1

Proportion

Primary organism

14

309

139

217

36

94

18

NT

NSW/ACT

Vic

Qld

SA

WA

Tas

0 .1 .2 .3 .4 .5

Proportion

Treating state

Values are total number of peritonitis episodes reported in 2012

Proportion of Episodes Resulting inPermanent Haemodialysis Transfer

6-24


Figure 6.58

24

12

6

4

Patient-

month

s p

er

epis

ode

.5

1

1.5

2

2.5

3

Epis

odes p

er

patient-

year

Confidence intervals not shown where upper limit >3Units with <5 person-years PD over 2012 not shown

2012 only

Peritonitis rates by treating unit

As demonstrated in Figure 6.62 there remains over a threefold variation in peritonitis rates between units. There are a number of individual characteristics which predict the occurrence of peritonitis, including older age, diabetes, cigarette smoking (but not centre size) and Aboriginal racial origin. These are covered in greater detail in a manuscript in Peritoneal Dialysis International (Ghali et al Perit Dial Inter 2011: 31(6):651-62). Similarly, there remains considerable variation between units (Figure 6.62), and between States (Figure 6.63).

Figure 6.59

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36

24

12

8

Patient-

month

s p

er

epis

ode

0.33

0.50

1.00

1.50

Epis

odes p

er

patient-

year

NT NSW/ACT Vic Qld SA WA Tas

All episodes of peritonitis 1/10/03 to 31/12/12

Rates of peritonitis by state

6-25


HAEMOGLOBIN

In Australia, at the end of 2012, haemoglobin was <110 g/L in 43% between 110-119 g/L in 28% of PD patients, the same as in 2012, and >140 g/L in 4%, which is similar to previous years.

In New Zealand, the corresponding percentages were very similar - 44%, 29% and 4% respectively.

Figure 6.61 shows the Haemoglobin levels in PD patients with proven or likely coronary artery disease .

Figure 6.60

38

29

19

95

43

27

18

74

43

28

17

84

39

29

20

94

44

27

19

83

44

29

17

64

Perc

ent


2010 2011 2012 2010 2011 2012

Haemoglobin - Peritoneal DialysisDecember 2010-2012

<110 110-119 120-129 130-139 140Hb(g/L)

Figure 6.61

40

27

19

95

44

27

18

75

41

27

18

95

36

31

18

105

42

28

17

84

46

28

1664

Perc

ent

No CAD CAD

2010 2011 2012 2010 2011 2012

Australia, December 2010-2012

Haemoglobin - Peritoneal DialysisBy Coronary Artery Disease Status

<110 110-119 120-129 130-139 140Hb(g/L)

37

32

20

83

43

27

20

82

45

29

1664

42

25

19

94

44

26

17

85

42

29

18

65

Perc

ent

No CAD CAD

2010 2011 2012 2010 2011 2012

New Zealand, December 2010-2012

Haemoglobin - Peritoneal DialysisBy Coronary Artery Disease Status

<110 110-119 120-129 130-139 140Hb(g/L)

6-26


Figures 6.62 - 6.65:

These figures show the median haemoglobin (with inter-quartile range) for individual centres, arranged from lowest to high-est (Figures 6.66 and 6.67). Also shown are the proportion of patients in each centre with a haemoglobin of 110-129 g/L (Figures 6.68 and 6.69).

In Australia, median haemoglobin for each centre ranged from 104 to 124 g/L for peritoneal dialysis patients and in New Zealand 104 -118 g/L.

The proportion of patients in Australia with a haemoglobin of 110-129 g/L in each centre ranged from 21% to 76% for peri-toneal dialysis patients and for New Zealand 29% to 63%. This large variation is likely to reflect differences in practices, protocols and patient case-mix among centres.

HAEMOGLOBIN IN PERITONEAL DIALYSIS PATIENTS

BY TREATING CENTRE

Figure 6.62


80

90

100

110

120

130

140

Me

dia

n H

b (

g/L

)

1 5 10 15 20 25 30 35 40 45

Caring Hospital


Haemoglobin in Peritoneal Dialysis Patients

Figure 6.63


80

90

100

110

120

130

140

Me

dia

n H

b (

g/L

)

1 2 3 4 5 6 7 8 9 10 11

Caring Hospital


Haemoglobin in Peritoneal Dialysis Patients

Figure 6.64


10

20

30

40

50

60

70

80

90

100

Pe

rce

nt

1 5 10 15 20 25 30 35 40 45

Caring Hospital


% Peritoneal Dialysis Patientswith Hb 110-129 g/L

Figure 6.65


10

20

30

40

50

60

70

80

90

100

Pe

rce

nt

1 2 3 4 5 6 7 8 9 10 11

Caring Hospital


% Peritoneal Dialysis Patientswith Hb 110-129 g/L

6-27


FERRITIN AND TRANSFERRIN SATURATION

Overall there are no remarkable trends in this area.

In both Australia and New Zealand, distributions of ferritin, transferrin saturation have remained stable for the past three years.

Figure 6.66

18

20

36

15

11

18

19

38

15

10

19

21

37

14

9

13

18

42

15

12

12

22

39

16

10

16

21

39

14

9

Perc

ent


2010 2011 2012 2010 2011 2012

Ferritin - Peritoneal DialysisDecember 2010-2012

<100 100-199 200-499 500-799 800g/L

Figure 6.67

33

39

19

9

30

43

17

10

32

42

17

9

28

42

19

11

30

41

19

10

29

46

17

8

Perc

ent


2010 2011 2012 2010 2011 2012

Transferrin Saturation - Peritoneal DialysisDecember 2010-2012

<20 20-29 30-39 40T/Sat(%)

6-28


FERRITIN BY TREATING CENTRE

The proportions of patients in each centre with ferritin between 200-500 mcg/L and transferrin saturation of >20% respective-ly, as recommended by the CARI guidelines, are shown in Figures 6.68-6.71.

In Australia, the proportions of patients with ferritin within this range in each centre varied widely between 8-61% for peritoneal dialysis patients. Similarly large variations between centres were seen for transferrin saturation, between 31-85%. Again, this large variation may reflect differences in practices, protocols and patient case-mix among centres.

In New Zealand, the corresponding figures for ferritin were between 24-48% for peritoneal dialysis patients and for transferrin saturation between 40-84%. In both countries, significant proportions of patients did not have ferritin and transferrin saturation within the recommended ranges.

Figure 6.69


10

20

30

40

50

60

70

80

90

100

Pe

rce

nt

1 2 3 4 5 6 7 8 9 10 11

Caring Hospital


% Peritoneal Dialysis Patientswith Ferritin 200-500 g/L

Figure 6.70


10

20

30

40

50

60

70

80

90

100

Pe

rce

nt

1 5 10 15 20 25 30 35 40

Caring Hospital


% Peritoneal Dialysis Patients with TSat>20%

Figure 6.71


10

20

30

40

50

60

70

80

90

100

Pe

rce

nt

1 2 3 4 5 6 7 8 9 10 11

Caring Hospital


% Peritoneal Dialysis Patients with TSat>20%

Figure 6.68


10

20

30

40

50

60

70

80

90

100

Pe

rce

nt

1 5 10 15 20 25 30 35 40

Caring Hospital

Australia 31 December

% Peritoneal Dialysis Patientswith Ferritin 200-500 g/L

6-29


SERUM CALCIUM

In both Australia and New Zealand the proportions of patients with proportions with serum calcium ≥2.4 mmol/L and < 2.2 mmol/L have remained fairly stable (Figure 6.72)

Figures 6.73 and 6.74 show the proportions of patients at each centre with serum calcium 2.1-2.4 mmol/L, as rec-ommended by the CARI guidelines. Note however that the values in the guidelines were for corrected total calci-um, while those in this report are for uncorrected total calcium.

In Australia, the proportions ranged widely between 34-75% for peritoneal dialysis patients, while in New Zealand the corresponding proportions were 52-72%.

SERUM CALCIUM BY TREATING CENTRE

Figure 6.72

11

28

40

17

4

11

31

38

16

5

11

30

39

164

6

22

38

25

9

5

21

43

24

7

6

20

40

26

8

Perc

ent


2010 2011 2012 2010 2011 2012

Serum Calcium - Peritoneal DialysisDecember 2010-2012

<2.0 2.0-2.1 2.2-2.3 2.4-2.5 2.6Calcium(mmol/L)

Figure 6.73


10

20

30

40

50

60

70

80

90

100

Pe

rce

nt

1 5 10 15 20 25 30 35 40 45

Caring Hospital


% Peritoneal Dialysis Patientswith Calcium 2.1-2.4 mmol/L

Figure 6.74


10

20

30

40

50

60

70

80

90

100

Pe

rce

nt

1 2 3 4 5 6 7 8 9 10 11

Caring Hospital


% Peritoneal Dialysis Patientswith Calcium 2.1-2.4 mmol/L

6-30


SERUM PHOSPHATE

In Australia, serum phosphate has stabilized over the last three years (reflected in the size of the ≥ 1.8 mmol/L group) (Figure 6.75)

In New Zealand, the proportions with serum phosphate ≥ 1.8 mmol/L have remained stable.

SERUM PHOSPHATE BY TREATING CENTRE

Figures 6.76 - 6.77 show the proportions of patients at each centre with serum phosphate 0.8-1.6 mmol/L, as recommended by the CARI guidelines.

In Australia, the proportions ranged widely between 8-80% for peritoneal dialysis patients and in New Zea-land, the corresponding proportions were 32-55%.

Figure 6.76


10

20

30

40

50

60

70

80

90

100

Pe

rce

nt

1 5 10 15 20 25 30 35 40 45

Caring Hospital


% Peritoneal Dialysis Patients withPhosphate 0.8-1.6 mmol/L

Figure 6.77


10

20

30

40

50

60

70

80

90

100

Pe

rce

nt

1 2 3 4 5 6 7 8 9 10 11

Caring Hospital


% Peritoneal Dialysis Patients withPhosphate 0.8-1.6 mmol/L

Figure 6.75

28

17

16

38

28

17

18

37

26

19

17

38

26

15

15

43

24

16

18

42

24

19

17

41

Perc

ent


2010 2011 2012 2010 2011 2012

Serum Phosphate - Peritoneal DialysisDecember 2010-2012

<1.4 1.4-1.5 1.6-1.7 1.8Phosphate (mmol/L)

6-31


CALCIUM-PHOSPHATE PRODUCT

In both Australia and New Zealand, calcium-phosphate product has remained steady, with smaller proportions of patients with a product ≥ 3.5 mmol2/L2. (Figure 6.82).

Overall, the proportion of people with high calcium-phosphate product was higher in New Zealand than Australia.

CALCIUM-PHOSPHATE PRODUCT BY TREATING CENTRE

Figures 6.79 - 6.80 show the proportions of patients at each centre with calcium-phosphate product <4.0 mmol2/L2, as recommended by the CARI guidelines.

In Australia, the proportions ranged widely between 39-93% for peritoneal dialysis patients while in New Zealand, the corresponding proportions were 42-68%.

Figure 6.78

43

18

15

10

15

44

19

139

15

43

19

14

9

15

39

16

16

10

20

37

18

17

9

18

37

18

15

11

18

Perc

ent


2010 2011 2012 2010 2011 2012

December 2010-2012

Calcium Phosphate ProductPeritoneal Dialysis

<3.5 3.5-3.9 4.0-4.4 4.5-4.9 5.0Ca X PO4 (mmol2/L

2)

Figure 6.80


10

20

30

40

50

60

70

80

90

100

Pe

rce

nt

1 2 3 4 5 6 7 8 9 10 11

Caring Hospital


% Peritoneal Dialysis Patients withCa X PO4 < 4.0 mmol

2/L

2

Figure 6.79


10

20

30

40

50

60

70

80

90

100

Pe

rce

nt

1 5 10 15 20 25 30 35 40 45

Caring Hospital


% Peritoneal Dialysis Patients withCa X PO4 < 4.0 mmol

2/L

2

Philip Clayton

Blair Grace

Jeremy Chapman

Jenni Wright

Stephen McDonald

CHAPTER 7

TRANSPLANT WAITING LIST


Data from ANZDATA and the Na onal Organ Matching System

of Australia (NOMS)

7-2

TRANSPLANT WAITING LIST ANZDATA Registry 2013 Report _____________________________________________________________________________________

The waiting list data reported here are derived from the Australian National Organ Matching System (NOMS) and ANZDATA. We are working with the New Zealand Blood Service to undertake similar analyses for NZ patients. Waiting list data refers to waiting for deceased donor (DD) kidney-only transplants. Patients wait-listed for multi-organ transplants are excluded. Recipients of living donor (LD) transplants may or may not be on the waiting list prior to transplantation. To understand the relative contributions of deceased and living donor transplants to patients on / not on the kidney-only waiting list, DD and LD transplants to recipients not on the kidney-only waiting list are also included. The numbers of people moving on and off the active waiting list for any reason are shown. Patients are categorised as either active or off the list - an “interim” or “temporarily off list” status is considered to be off list, since these patients will not be allocated kidneys. A number of de-listed patients may return to the list in subsequent years. If a patient was listed and de-listed more than once in a calendar year, only the net change is counted. In the tables below, the rows describe: Number on the active list at the beginning of the year Number added to the active list during the year Number removed from the active list during the year Number of deceased donor (DD) transplants to people on the waiting list Number of living donor (LD) transplants to people on the waiting list Number of transplants performed outside Australia / New Zealand to people on the waiting list Number who died while on the active waiting list Number on the waiting list at the end of the year Number of DD transplants to recipients not on the waiting list* Number of LD transplants to recipients not on the waiting list * includes patients listed for a multi-organ transplant who received a kidney transplant +/- another organ, and rarely, manual allocation of a DD kidney to a patient not on the waiting list Figure 7.1 shows the basic stock and flow tables for Australia for each year. The number of patients waiting for a kidney transplant has been steadily falling over time despite increasing numbers of patients being listed each year. Figure 7.2 shows these data for non-indigenous and indigenous patients respectively.

Figure 7.1

Australian Deceased Donor Kidney Waiting List Stock and Flow Totals

Event 2007 2008 2009 2010 2011 2012

Active start of year 1339 1333 1251 1264 1183 1087

Made active 592 653 670 630 707 736

Taken off list 167 182 178 149 197 153

Deceased donor transplant 315 417 401 499 533 554

Living donor transplant 95 122 64 58 62 45

Overseas transplant 8 2 4 1 2 0

Died on list 13 12 10 4 9 6

Active end of year 1333 1251 1264 1183 1087 1065

Deceased donor transplant off list 29 42 45 51 37 53

Living donor transplant off list 176 232 263 238 193 193

7-3

ANZDATA Registry 2013 Report TRANSPLANT WAITING LIST _____________________________________________________________________________________

Figure 7.2

Australian Deceased Donor Kidney Waiting List

Stock and Flow for each Year by Indigenous Status

Race Event 2007 2008 2009 2010 2011 2012

Non-indigenous


Made active 573 621 642 592 678 706

Taken off list 162 174 167 141 178 145




Died on list 13 10 10 3 9 5


Deceased donor transplant off list

29 42 42 48 36 53



Made active 19 32 28 38 29 30

Taken off list 5 8 11 8 19 8




Died 0 2 0 1 0 1


Deceased donor transplant off list

0 0 3 3 1 0


Indigenous

The numbers of both dialysis patients and transplants vary with age; in Figure 7.3 the stock and flow for the years 2008-12 is shown by broad age groups. As expected, older patients are less likely to be listed than younger patients, and the proportion removed from the list is higher.

7-4


Figure 7.3


Stock and Flow for each Year by Age

Age Event 2007 2008 2009 2010 2011 2012

< 45


Made active 186 186 227 212 268 274

Taken off list 31 53 38 42 43 39




Died 2 1 2 0 2 3




45 - 54


Made active 170 175 180 175 192 217

Taken off list 42 45 37 43 61 41




Died 2 4 3 1 4 1




55 - 64


Made active 160 203 194 181 202 196

Taken off list 58 44 68 36 64 57




Died 8 6 4 2 3 2





Made active 76 89 69 62 45 49

Taken off list 36 40 35 28 29 16




Died 1 1 1 1 0 0




65 +

7-5


Figure 7.4


Stock and Flow for each Year by State

State Event 2007 2008 2009 2010 2011 2012

NSW/ACT


Made active 240 248 217 200 250 261

Taken off list 90 105 107 71 108 80




Died on list 9 6 9 2 7 2




VIC/TAS


Made active 144 169 203 212 212 244

Taken off list 36 43 38 38 44 43









Made active 97 123 123 101 116 112

Taken off list 19 10 18 22 15 12








QLD

7-6


Figure 7.4 (contd…)


Stock and Flow for each Year by State

State Event 2007 2008 2009 2010 2011 2012

SA/NT


Made active 74 74 62 61 72 76





Died 0 1 1 0 0 1





Made active 37 39 65 56 57 43





Died 2 2 0 1 1 0




WA

Differences between states (combined into transplanting regions) are shown in figure 7.4. Approximately half of all patients on the waiting list are in NSW. Waiting list numbers in each state are reflective of both listing practices and donation rates, both current and historical. The fall in the number of wait-listed patients has predominantly occurred in NSW, and to a lesser extent WA.

7-7


Figure 7.5


Stock and Flow for each Year by Blood Group

Blood Event 2007 2008 2009 2010 2011 2012

A


Made active 219 222 258 233 242 286

Taken off list 50 63 56 57 58 44








AB


Made active 16 18 21 25 35 29







Deceased donor transplant off list 2 1 4 4 2 1 Living donor transplant off list 2 12 9 10 3 12

B


Made active 75 71 89 80 92 111

Taken off list 22 26 24 17 27 26






Deceased donor transplant off list 0 4 6 5 1 3 Living donor transplant off list 13 27 30 23 29 21


Made active 281 342 302 292 338 310

Taken off list 92 91 98 73 110 82








O

Figure 7.5 shows the same data by blood group. Turnover is highest for blood group AB patients and generally lowest for blood group O. The totals are slightly lower than Figure 7.1 due to a small number of patients with missing blood group data (13 in 2012).

7-8


Figure 7.6 shows the survival of patients who commenced dialysis in Australia over 2007-2012 and were subsequently wait-listed for a deceased donor kidney-only transplant. Survival is shown from the time of listing and is censored at transplantation (but not at removal from the list). The mortality rate of this highly selected patient group was low at 1.6 deaths per 100 patient-years (95% CI 1.3-2.1).

0.00

0.25

0.50

0.75

1.00

2471 1215 641 342 159 Number at risk

0 1 2 3 4

Years since wait-listing

Survival from first listing for kidney-only transplantExcludes patients who receieved a living donor or overseas transplant prior to wait-listing

Australian incident dialysis patients 2007-2012Censored at transplantation

Survival after wait-listing

Figure 7.6

Philip Clayton

Wai Lim

Kylie Hurst

CHAPTER 8

TRANSPLANTATION


TRANSPLANTATION ANZDATA Registry 2013 Report _____________________________________________________________________________________

8-2

TRANSPLANTS PERFORMED IN 2012

AUSTRALIA The 845 transplant operations performed in 2012 represent a slight increase over 2011. This was driven by an increase in the number of deceased donor kidney transplants, offset-ting a continuing fall in living donor numbers.

The 2012 numbers represent a transplant rate of 37 per million population per year, un-changed from 2011. The progressive increase in the number of kidney transplants from non-heart beating donors appears to have stabi-lised (Figure 8.4).

For more up to date figures on the deceased organ donor rate, see www.anzdata.org.au/anzod/updates/anzodupdate.htm

Living donor transplants accounted for 28% (238 grafts) in 2012, down from 31% in 2011 and 35% in 2010.

Primary recipients (those receiving a first transplant) received 88% of all kidneys trans-planted in 2012, similar to recent years.

NEW ZEALAND The number of transplant operations (108) performed in 2012 represents a transplant rate of 24 per million population per year com-pared with 27 in 2011 (Figure 8.1).

The percentage of living donors remained steady at 50% of all operations in 2012 (Figure 8.3). There were no transplants from non-heart beating donors in 2012.

Of the grafts performed in 2012, 92% were to primary recipients.

Figure 8.1

Number of Kidney Transplant Operations Total (Living Donors)

Year Australia New Zealand

1st 2nd 3rd 4th 5th Total 1st 2nd 3rd 4th Total

1963 5 1 0 0 0 6 (0) 0 0 0 0 0

1964 2 0 0 0 0 2 (0) 0 0 0 0 0

1965 12 1 1 0 0 14 (3) 1 0 0 0 1 (1)

1966 18 2 0 0 0 20 (5) 10 3 0 0 13 (0)

1967 69 2 0 0 0 71 (2) 18 4 1 0 23 (1)

1968 97 10 0 0 0 107 (0) 17 4 0 0 21 (2)

1969 149 12 0 0 0 161 (0) 39 5 0 0 44 (0)

1970 168 12 2 0 0 182 (1) 21 3 1 0 25 (0)

1971 207 22 1 0 0 230 (1) 26 6 0 0 32 (1)

1972 183 16 0 0 0 199 (2) 43 8 0 0 51 (1)

1973 213 30 1 0 0 244 (7) 50 10 2 0 62 (0)

1974 224 35 4 0 0 263 (6) 35 5 1 0 41 (3)

1975 271 29 3 1 0 304 (7) 61 13 0 0 74 (2)

1976 223 41 4 0 0 268 (10) 38 13 1 0 52 (1)

1977 265 57 4 0 0 326 (16) 46 10 2 0 58 (4)

1978 269 43 2 0 0 314 (17) 43 11 3 0 57 (11)

1979 293 35 5 0 0 333 (34) 61 13 3 2 79 (16)

1980 287 63 9 0 0 359 (36) 57 13 4 0 74 (18)

1981 306 58 9 1 0 374 (35) 51 8 1 0 60 (10)

1982 321 72 6 0 0 399 (53) 48 17 0 0 65 (8)

1983 272 63 10 2 0 347 (48) 69 25 4 0 98 (11)

1984 362 72 10 1 0 445 (48) 63 11 0 0 74 (16)

1985 318 79 17 1 0 415 (36) 60 25 3 0 88 (6)

1986 366 63 7 2 0 438 (32) 79 19 6 1 105 (13)

1987 310 58 21 3 0 392 (40) 57 17 4 1 79 (20)

1988 391 62 10 2 1 466 (46) 61 11 6 0 78 (8)

1989 433 46 10 2 0 491 (48) 71 11 1 0 83 (12)

1990 387 45 9 2 0 443 (59) 86 14 2 0 102 (23)

1991 386 70 11 3 0 470 (78) 62 10 4 1 77 (13)

1992 404 57 13 3 0 477 (70) 105 5 5 0 115 (17)

1993 385 63 6 4 1 459 (66) 68 13 2 0 83 (20)

1994 384 41 12 2 1 440 (103) 70 11 1 1 83 (20)

1995 371 60 11 0 0 442 (94) 84 7 3 0 94 (24)

1996 416 50 9 0 0 475 (115) 88 7 1 0 96 (26)

1997 447 51 6 1 0 505 (147) 101 10 1 0 112 (31)

1998 443 62 11 2 0 518 (161) 95 10 1 0 106 (31)

1999 403 43 9 0 0 455 (169) 97 11 4 0 112 (42)

2000 476 47 7 1 0 531 (181) 91 13 2 0 106 (31)

2001 488 45 6 2 0 541 (213) 101 9 0 0 110 (43)

2002 537 60 5 2 0 604 (230) 103 12 2 0 117 (48)

2003 472 60 10 1 0 543 (218) 94 13 4 0 111 (44)

2004 583 53 11 3 0 650 (244) 98 7 0 0 105 (48)

2005 539 67 15 2 0 623 (246) 87 5 0 1 93 (46)

2006 549 70 17 5 0 641 (273) 80 8 2 0 90 (49)

2007 527 75 11 0 2 615 (271) 112 9 2 0 123 (58)

2008 708 84 16 5 0 813 (354) 111 10 1 0 122 (69)

2009 674 88 11 0 0 773 (327) 109 12 0 0 121 (67)

2010 744 83 18 1 0 846 (296) 104 5 1 0 110 (60)

2011 744 68 10 3 0 825 (255) 110 7 1 0 118 (57)

2012 747 80 15 1 2 845 (238) 99 9 0 0 108 (54)

8-3

ANZDATA Registry 2013 Report TRANSPLANTATION _____________________________________________________________________________________

Figure 8.2

354

459

327

446

296

550

255

570

238

607

0

200

400

600N

umbe

r of

tran

spla

nts

2008 2009 2010 2011 2012

Australia 2008-2012

Deceased and Living Donor Transplants

Living donor

Deceased donor

Figure 8.3

69

53

67

5460

5057

6154 54

0

20

40

60

80

Num

ber

of tr

ansp

lant

s

2008 2009 2010 2011 2012


Deceased and Living Donor Transplants

Living donor

Deceased donor

Figure 8.4

43

75

117

151

129

0

50

100

150

Nu

mb

er

of t

ran

spla

nts

2008 2009 2010 2011 2012

Australia 2008-2012

Transplants from Non-Heart Beating Donors

416

371

433 419

478

0

100

200

300

400

500

Num

ber

of t

rans

plan

ts

2008 2009 2010 2011 2012

Australia 2008-2012

Transplants from Heart Beating Donors


8-4

TRANSPLANT RATE OF PATIENTS DIALYSED

In Australia transplantation was performed in 6% of patients who received dialysis in 2012.

Of all patients in the 15-64 year age group who received dialysis treatment during 2012, 10% were transplanted in 2012, the same as in 2011 (Figure 8.6).

The ratio of transplantation to numbers dialysing in Australia was the highest in the age groups 5-14 years (41%) and 0-4 and 15-24 years of age (24%) and declined with increasing age (Figure 8.7).

In New Zealand transplantation was performed for 4% of patients, the same percentage as 2011 (Figure 8.5).

As in Australia, the rate of transplantation for New Zealand patients was highest among those less than 14 years old (Figure 8.8).

* Pre-emptive transplant patients included

Figure 8.5

6

5

6

7

6

8

3

6 6

4

0

2

4

6

8

% t

rans

plan

ted

QLD NSW ACT Vic Tas SA NT WA Aust NZ

Related to patients dialysed

Ratio of Transplantation 2012

Figure 8.6

10

8

12

14

11

16

3

10 10

5

0

5

10

15

20

% t

rans

plan

ted

QLDNSWACT Vic Tas SA NT WA Aust NZ

Related to patients dialysed, ages 15-64

Ratio of Transplantation 2012

Living

Deceased

Figure 8.7

24

41

24

18

1211

7

20 0

0

10

20

30

40

% t

ran

spla

nte

d

0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Age


Ratio of Transplantation 2012 - Australia

Figure 8.8

0

63

410

5 4 4 2 0 00

20

40

60

% t

rans

plan

ted

0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Age


Ratio of Transplantation 2012 - New Zealand

8-5


AGE OF RECIPIENTS TRANSPLANTED IN 2012

AUSTRALIA

The median age of transplant recipients in 2012 was 49 years. The age range was 1 to 80 years (Figures 8.9 and 8.10).

The transplantation rate per million for each age group and as a percentage of dialysed patients for each age group are shown in Figures 8.7 and 8.10.

NEW ZEALAND

The median age of transplant recipients in 2012 was 50.5 years. The age range was 8 to 73 years (Figures 8.8 and 8.11).

Recipients aged between 35 and 54 years comprised 26% of the total. Sixty-two percent of recipients were over 54 years of age in 2012.

Figure 8.9

Graft Number and Age of Patients Transplanted 2012

Donor Source

Graft No.

Age Groups Total

00-04 05-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84

Australia

Deceased

1 2 6 16 66 85 143 155 58 2 533

2 0 0 4 4 12 25 14 2 0 61

3 0 0 2 0 3 5 1 0 0 11

Living Donor

4 0 0 0 0 1 1 0 0 0 2

1 5 13 29 23 41 40 43 18 2 214

2 0 0 2 6 6 2 1 2 0 19

3 0 0 0 0 1 3 0 0 0 4

4 0 0 0 0 0 1 0 0 0 1

Total 7 19 53 99 149 220 214 80 4 845

New Zealand

Deceased 1 0 0 3 0 10 5 9 16 7 50

2 0 0 0 0 0 0 3 1 0 4

Living Donor 1 0 0 7 2 3 8 8 17 4 49

2 0 0 0 1 1 1 2 0 0 5

Total 0 0 10 3 14 14 22 34 11 108

Figure 8.10

5 7

17

30

47

72

81

46

4

0

20

40

60

80

Tra

nspl

ants

per

mill

ion

popu

latio

n

0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84

Age

Australia

Transplant Operations (per million) 2012

Figure 8.11

17

5

24 24

36

68

32

0

20

40

60

80

Tra

nspl

ants

per

mill

ion

popu

latio

n

5-14 15-24 25-34 35-44 45-54 55-64 65-74

Age

New Zealand

Transplant Operations (per million) 2012


8-6

ETHNICITY OF TRANSPLANT RECIPIENTS

AUSTRALIA

Figure 8.12.

For the 15-64 year age group in 2012, 13.0% of dialysed Caucasian patients were transplanted. For Australian Aboriginals and Torres Strait Islanders (ATSI), the numbers receiving transplants remains low.

In contrast, the number of ATSI patients dialysed continues to increase each year.

NEW ZEALAND Figure 8.13.

Amongst the 15-64 year age group, the proportion of Maori and Pacific People who received a renal transplant in 2011 was substantially lower than other groups.


Transplantation Rate - Age Group 15-64 years 2003 - 2012

Year Caucasian Aboriginal and

Torres St. Islanders All Patients

Tx Dialysed Rate Tx Dialysed Rate Tx Dialysed Rate

2003 414 3790 10.9% 12 783 1.5% 478 5251 9.1%

2004 491 3875 12.7% 25 856 2.9% 581 5438 10.7%

2005 460 4040 11.4% 20 930 2.2% 548 5716 9.6%

2006 481 4241 11.3% 27 989 2.7% 579 6039 9.6%

2007 471 4380 10.8% 17 1065 1.6% 557 6331 8.8%

2008 602 4488 13.4% 29 1176 2.5% 724 6632 10.9%

2009 574 4497 12.8% 23 1199 1.9% 687 6719 10.2%

2010 607 4438 13.7% 27 1215 2.2% 734 6727 10.9%

2011 550 4474 12.3% 25 1274 2.0% 695 6879 10.1%

2012 585 4512 13.0% 19 1337 1.4% 734 7082 10.4%


Transplantation Rate - Age Group 15-64 years 2003 - 2012

Year Caucasian Maori Pacific People All Patients

Tx Dialysed Rate Tx Dialysed Rate Tx Dialysed Rate Tx Dialysed Rate

2003 64 545 11.7% 16 531 3.0% 13 271 4.8% 101 1442 7.0%

2004 65 542 12.0% 10 558 1.8% 12 285 4.2% 96 1483 6.5%

2005 73 568 12.9% 3 563 0.5% 3 303 1.0% 82 1523 5.4%

2006 59 567 10.4% 9 606 1.5% 5 322 1.6% 80 1599 5.0%

2007 82 576 14.2% 15 616 2.4% 6 344 1.7% 111 1648 6.7%

2008 84 586 14.3% 12 620 1.9% 9 376 2.4% 112 1699 6.6%

2009 77 599 12.9% 13 637 2.0% 6 405 1.5% 101 1783 5.7%

2010 62 593 10.5% 17 662 2.6% 8 445 1.8% 95 1860 5.1%

2011 67 606 11.1% 18 652 2.8% 7 467 1.5% 104 1887 5.5%

2012 60 601 10.0% 12 672 1.8% 7 488 1.4% 88 1942 4.5%

Figure 8.14

New Transplanted Patients 2008 - 2012 Related to Ethnicity

Race 2008 2009 2010 2011 2012

Australia 813 (100.0%) 773 (100.0%) 846 (100.0%) 825 (100.0%) 845 (100.0%)

Caucasian 675 (83.0%) 651 (84.2%) 706 (83.5%) 657 (79.6%) 669 (79.2%)

Aboriginal/Torres St. Islanders 31 (3.8%) 24 (3.1%) 28 (3.3%) 28 (3.4%) 20 (2.4%)

Asian 83 (10.2%) 75 (9.7%) 83 (9.8%) 97 (11.8%) 88 (10.4%)

Other 24 (3.0%) 23 (3.0%) 29 (3.4%) 43 (5.2%) 68 (8.0%)

New Zealand 122 (100.0%) 121 (100.0%) 110 (100.0%) 118 (100.0%) 108 (100.0%)

Caucasian 93 (76.2%) 91 (75.2%) 71 (64.5%) 77 (65.3%) 74 (68.5%)

Asian 7 (5.7%) 5 (4.1%) 8 (7.3%) 11 (9.3%) 11 (10.2%)

Maori 12 (9.8%) 19 (15.7%) 20 (18.2%) 20 (16.9%) 15 (13.9%)

Pacific 10 (8.2%) 6 (5.0%) 9 (8.2%) 9 (7.6%) 7 (6.5%)

Other - - 2 (1.8%) 1 (0.8%) 1 (0.9%)

AUSTRALIA AND NEW ZEALAND Figure 8.14 shows these data in another format.

In Australia in 2012, 2.4% of transplant recipients were of Aboriginal/TSI ethnicity.

In New Zealand, 13.9% of transplant recipients were Maoris and 6.5% were Pacific People.

8-7


AUSTRALIAN REGIONAL TRANSPLANTATION ACTIVITY

The rate of transplantation for each transplant region is shown in Figures 8.15 and 8.16.

Transplants performed for people resident in Tasmania and the Northern Territory patients are included in figures for Victoria and South Australia regions respectively. These regions share common waiting lists and allocation protocols.

The transplant rates for residents of each State and New Zealand are shown in Figure 8.17.

The highest rate (65 per million) occurred in the Northern Territory, followed by South Australia (48 per million) and Victoria (44 per million). The lowest rate (29 per million) was in Tasmania.

Figure 8.15

Transplants in each Region 2008 - 2012 Number of Operations

(per Million Population per year)

State 2007 2008 2009 2011

Queensland 136 (32) 140 (32) 137 (31) 159 (35)

New South Wales / ACT * 243 (33) 238 (32) 265 (35) 247 (32)

Victoria / Tasmania * 246 (42) 233 (39) 285 (48) 268 (44)

South Australia / NT * 110 (60) 83 (45) 82 (44) 88 (47)

Western Australia 78 (36) 79 (35) 77 (34) 83 (34)

Australia 813 (38) 773 (35) 846 (38) 845 (37)

* For calculation of population related totals, the populations of these States were summed

2010

155 (35)

232 (31)

278 (46)

74 (40)

86 (37)

825 (37)

NSW population excludes residents of the Southern Area Health Service ACT population includes residents of the Southern Area Health Service

Medical services in the ACT service the Southern Area Region

Figure 8.17

3631

34

44

29

48

65

3537

25

0

20

40

60

Rat

e o

f tra

nspl

anta

tion

QLDNSWACT Vic Tas SA NT WA Aust NZ

Related to population (per million)

Rate of Transplantation 2012

Deceased

Living

0

20

40

60

80

Tra

nspl

ants

per

mill

ion

popu

latio

n

0

20

40

60

80

Tra

nspl

ants

per

mill

ion

popu

latio

n

2008 2009 2010 2011 2012

Year

QLDNSW/ACTVic/TasSA/NT

WA

Australian transplant regions

Transplant Operations 2008-2012

Figure 8.16


8-8

FUNCTIONING TRANSPLANTS AT 31ST DECEMBER 2012

Figure 8.18

Summary of Kidney Transplantation

Australia 1963 - 2012 Graft No. Performed Functioning*

Deceased Donor

First 13386 5132

Second 1997 615

Third 326 105

Fourth 48 14

Fifth 6 2

Total 15763 5868

Living Donor

First 4462 3121

Second 409 262

Third 59 44

Fourth 10 8

Fifth 1 0

Total 4941 3435

First 0 15

Second 0 2

Total 20704 9320

* Lost to follow up not included

Unknown

Figure 8.19

Summary of Kidney Transplantation

New Zealand 1965 - 2012

Performed Functioning*

Deceased Donor

First 2282 748

Second 400 78

Third 76 18

Fourth 7 0

Total 2765 844

Living Donor

First 998 626

Second 82 48

Third 6 4

Total 1086 678

Total 3851 1524

* Lost to follow up not included

Unknown First 0 2

AUSTRALIA There have been 20,704 transplant operations performed on 17,884 patients since 1963. Fourteen percent of transplanted kidneys and 14% of functioning grafts were regrafts. Living donor transplants accounted for 24% of operations.

There were 9320 patients with functioning grafts at the end of 2012. Of these, 63% were from deceased donors. The number of functioning grafts at the end of 2012 represents a 5% increase over the previous year. The annual rate of increase has remained steady (Figures 8.20 and 8.21).

The prevalence of functioning grafts in each State is shown in Figures 8.20 and 8.21. South Australia/Northern Territory had the highest prevalence of functioning renal transplants (547 per million). The lowest prevalence was in Western Australia (372 per million) and NSW/ACT (374 per million).

The age distribution of functioning transplants as a proportion of patients on renal replacement therapy is shown in Figure 8.23. The proportion depending on living donor grafts is greater in the younger age groups (Figures 8.23 and 8.24).

The details of age are shown Figure 8.25, and details of age, gender and ethnicity are shown in figure 8.28.

The majority of recipients with functioning grafts were male (61%). The ethnic origin of recipients was Caucasian 85%, Asian 9.5%, Aboriginal and Torres Strait Islanders 2% and Others 3% (Figure 8.28).

Thirty-five percent of grafts were functioning ten or more years and 9% for 20 or more years. There were 205 recipients with grafts functioning 30 years or longer (Figure 8.29). The longest functioning graft had functioned for 44 years at 31st December, 2012.

NEW ZEALAND There have been 3,851 operations performed on 3,287 patients since 1965 (Figure 8.19). Fifteen percent of operations were regrafts. Kidneys from living donors accounted for 28% of operations.

There were 1,524 patients with functioning grafts at the end of 2011. Of these, 10% were regrafts.

The age relationship and donor source are shown in Figure 8.25. The majority were male (59%) and the racial distribution was Caucasian 75%, Maori 10%, Pacific People 6% and Asian 8% (Figure 8.28).

The majority (68%) of patients with functioning grafts were in the 35-64 year age group and the mean and median ages were 51 and 53 years respectively. The modal age group was 55-64 years (Figure 8.25).

The longest surviving graft had functioned for 42 years at 31st December 2012. There were 168 grafts functioning for 20 or more years and 30 for 30 or more years (Figure 8.30).

8-9


Figure 8.20

Functioning Transplants 2003 - 2012 Transplanting Region, Australia and New Zealand

(Number Per Million Population) Year QLD NSW/ACT * VIC/Tas * SA/NT * WA Australia NZ

2003 1243 (326) 1976 (282) 1593 (295) 726 (419) 551 (282) 6089 (306) 1164 (289)

2004 1289 (330) 2077 (295) 1671 (306) 773 (444) 585 (295) 6395 (318) 1218 (298)

2005 1329 (333) 2148 (303) 1756 (317) 783 (445) 640 (317) 6656 (326) 1243 (301)

2006 1376 (336) 2232 (312) 1870 (333) 825 (464) 684 (332) 6987 (338) 1256 (300)

2007 1425 (341) 2286 (316) 1961 (344) 870 (484) 709 (335) 7251 (345) 1300 (307)

2008 1505 (352) 2394 (327) 2095 (362) 912 (502) 748 (343) 7654 (358) 1350 (316)

2009 1576 (361) 2497 (336) 2252 (382) 935 (508) 787 (350) 8047 (370) 1404 (325)

2010 1649 (373) 2648 (353) 2416 (404) 975 (524) 818 (356) 8506 (386) 1440 (330)

2011 1717 (384) 2740 (362) 2573 (426) 988 (528) 860 (366) 8878 (398) 1483 (337)

2012 1810 (400) 2866 (374) 2718 (444) 1029 (547) 897 (372) 9320 (413) 1524 (344)

* For calculation of population related totals, the population of these States were combined Patients lost to follow up are not included

Figure 8.21

100

200

300

400

500

600

700

100

200

300

400

500

600

700

Per

mill

ion

popu

latio

n

2002 2004 2006 2008 2010 2012

Year

QLDNSW/ACTVic/TasSA/NT

WA

Australia 2003-2012

Functioning Transplants by Region

Figure 8.22

400374 382

445 437

578

331372

413

344

0

200

400

600

Tra

nspl

ants

per

mill

ion

popu

latio

n

QLD NSW ACT Vic Tas SA NT WA Aust NZ

Per million population

Prevalence of Functioning Transplants 31 Dec 2012

Figure 8.23

111

3550

57636466

8543

0 20 40 60 80 100

Percentage of patients

85+

75-84

65-74

55-64

45-54

35-44

25-34

15-24

5-14

0-4

Age

As mode of RRT, Australia 2012

Prevalence of Functioning Transplants

Living donor

Deceased donor

Figure 8.24

1416

2937

45484848

8767

0 20 40 60 80 100

Percentage of patients

85+

75-84

65-74

55-64

45-54

35-44

25-34

15-24

5-14

0-4

Age

As mode of RRT, New Zealand 2012

Prevalence of Functioning Transplants

Living donor

Deceased donor


8-10

Figure 8.25

Age of All Functioning Transplant Patients Resident Country at Transplant 31-Dec-2012

Donor Source

Graft No.

Age Groups Total

00-04 05-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85-94

12 136 292 708 1559 2258 2508 1527 314 6 9320

Deceased Donor

1 6 40 89 249 715 1240 1538 1022 228 5 5132

2 - 4 8 40 103 198 163 82 16 1 615

3 - - 2 8 25 41 18 11 - - 105 4 - - - - 5 6 3 - - - 14

5 - - - - - 1 1 - - - 2

Total 6 44 99 297 848 1486 1723 1115 244 6 5868

Living Donor

1 6 89 180 376 627 687 720 386 65 - 3136

2 - 3 12 32 71 64 56 21 5 - 264

3 - - 1 1 11 19 8 4 - - 44

4 - - - 2 2 2 1 1 - - 8

Total 6 92 193 411 711 772 785 412 70 - 3452

New Zealand 4 26 59 120 221 386 423 236 46 3 1524

Deceased Donor

1 2 5 12 51 82 178 224 151 41 2 748

2 - - 1 2 14 32 22 7 - - 78

3 - - - - 6 5 5 2 - - 18

Total 2 5 13 53 102 215 251 160 41 2 844

Living Donor

1 2 21 44 62 104 151 162 76 5 1 628

2 - - 2 5 14 17 10 - - - 48

3 - - - - 1 3 - - - - 4

Total 2 21 46 67 119 171 172 76 5 1 680

Australia

Figure 8.26

12136

292

708

1559

22582508

1527

314

6

0

500

1,000

1,500

2,000

2,500

Nu

mb

er

of t

ran

spla

nts

0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Age

Australia 2012 (n=9320)

Age Distribution of Functioning Transplants

8 4995

218

492

737

954879

310

14

0

200

400

600

800

1,000

Tra

nspl

ants

per

mill

ion

popu

latio

n

0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Age

Per million population, Australia 2012


Figure 8.27

426

59

120

221

386423

236

463

0

100

200

300

400

Num

ber

of tr

ansp

lant

s

0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Age

New Zealand 2012 (n=1524)


13 4592

209

373

624

844

687

240

40

0

200

400

600

800

Tra

nspl

ants

per

mill

ion

popu

latio

n

0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Age

Per million population, New Zealand 2012


8-11


Figure 8.28

Functioning Transplant Patients - Resident Country at Transplant Related to Ethnicity and Age Group 31-Dec-2012

Gender Racial Origin Prevalent Age Groups

Total 00-04 05-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85-94

Australia 12 136 292 708 1559 2258 2508 1527 314 6 9320

Female

Caucasian 2 34 100 235 492 690 778 524 132 2 2989

Aboriginal/TSI - 2 2 7 21 25 21 5 - - 83

Asian 1 4 8 30 78 101 133 47 7 - 409 Other 1 8 8 23 26 29 25 9 2 - 131

Total 4 48 118 295 617 845 957 585 141 2 3612

Male

Caucasian 6 68 147 355 808 1219 1335 852 158 4 4952

Aboriginal/TSI - 3 5 7 21 29 34 10 1 - 110

Asian - 7 13 32 83 126 139 63 11 - 474

Other 2 10 9 19 30 39 43 17 3 - 172

Total 8 88 174 413 942 1413 1551 942 173 4 5708

New Zealand 4 26 59 120 221 386 423 236 46 3 1524

Female

Caucasian - 8 25 28 75 115 129 76 20 1 477 Asian - 1 4 6 3 17 14 6 1 - 52

Maori - 4 4 6 14 12 9 6 3 - 58

Pacific - 1 - 7 6 14 6 3 1 - 38

Total - 14 33 47 98 158 158 91 25 1 625

Male

Caucasian 4 10 22 45 102 177 193 102 16 2 673

Asian - - - 11 8 12 27 13 3 - 74

Maori - 1 4 11 6 26 22 19 2 - 91

Pacific - 1 - 5 6 11 19 9 - - 51

Other - - - 1 1 2 4 2 - - 10

Total 4 12 26 73 123 228 265 145 21 2 899

Other - - - - - - - - - - -

Figure 8.29

0

200

400

600

800

Nu

mb

er

of f

un

ctio

nin

g g

rafts

<1 1 2 3 4 5 6 7 8 9 10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

Duration (years)

Australia 2012 (n=9320)

Number and Duration of Functioning Grafts

DeceasedLiving

Figure 8.30

0

50

100

Num

ber

of f

unct

ioni

ng g

raft

s

<1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

Duration (years)

New Zealand 2012 (n=1524)

Number and Duration of Functioning Grafts

DeceasedLiving


8-12

RATES OF GRAFT LOSS

Figure 8.31

Graft Loss Rate 2003 - 2012

2006 2007 2008 2009 2010 2012

Australia 7297 7602 8064 8427 8893 9723

Death with Function 2.0% 2.1% 2.1% 1.7% 2.0% 1.6% Loss of Graft Function 2.4% 2.5% 2.9% 2.7% 2.3% 2.4%

All Losses 4.4% 4.6% 5.0% 4.4% 4.3% 4.1%

New Zealand 1333 1379 1422 1471 1514 1591

Death with Function 2.6% 3.2% 1.8% 2.3% 2.2% 1.7% Loss of Graft Function 3.5% 2.9% 2.0% 2.4% 2.1% 2.4%

All Losses 6.0% 6.1% 3.9% 4.7% 4.4% 4.1%

2011

9331

2.3%

2.3%

4.7%

1558

2.7%

2.0%

4.7%

2005

7018

2.3%

2.7%

5.0%

1311

2.3%

3.4%

5.6%

2004

6739

2.1%

3.1%

5.2%

1269

2.2%

1.8%

4.0%

2003

6401

2.2%

2.6%

4.9%

1224

2.2%

2.5%

4.7%

Figure 8.32

Year of Graft Loss Due to Death or Failure 2003 - 2012

Loss Cause of Failure 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Total

Australia

Failed

Death with Function 146 146 165 146 165 175 148 177 221 164 1653

Rejection - Acute 3 5 3 7 11 10 17 8 10 10 84

Chronic Allograft (CAN) 112 145 136 108 133 174 153 149 151 178 1439

Rejection - Hyperacute - - - 1 - 2 - - - 1 4 Vascular 15 18 13 14 8 14 17 11 6 10 126 Technical Problems 3 2 4 5 2 4 3 3 5 2 33 Glomerulonephritis 12 13 16 23 15 10 15 15 15 16 150

Non Compliance 10 9 6 3 8 6 12 6 6 9 75 Other 13 20 15 19 17 16 15 18 26 25 184

Total 314 358 358 326 359 411 380 387 440 415 3748

New Zealand

Death with Function 27 27 31 34 44 26 34 33 41 27 324

Rejection - Acute 1 - 2 2 1 1 1 - 3 1 12

Chronic Allograft (CAN) 18 14 23 31 20 20 28 17 15 26 212

Rejection - Hyperacute - 1 - - - - - - - - 1 Vascular 1 - 4 - 3 1 2 3 2 1 17 Technical Problems 2 - 2 3 1 - - - - - 8

Glomerulonephritis 4 2 3 6 5 5 - 4 4 5 38

Non Compliance 3 - 1 1 6 1 1 5 3 - 21 Other 4 4 8 4 5 1 2 2 4 5 39

Total 60 48 74 81 85 55 68 64 72 65 672

Failed

The rates of loss of graft function and death with a functioning graft in Australia in 2012 were 2.4% and 1.6% per patient year respectively; in total 4.1% of grafts at risk were lost (Figure 8.31).

In 2012, the rate of loss of graft function in New Zealand was 2.4% and death with functioning graft was 1.7%; in total 4.1% of grafts at risk were lost (Figure 8.31).

The causes of graft failure from 2003 to 2012 are shown in Figure 8.32.

Chronic allograft nephropathy and death with function remain the key impediments to long term graft survival.

The importance of death with function, chronic allograft nephropathy and other causes of graft loss after one year is evident in Figure 8.33. Among the causes of death with functioning graft, cardiovascular disease and malignancy were predominant.

8-13


Figure 8.33

Graft Losses 2008 - 2012


Graft Function Graft Function

<1 year >= 1 year Any Time <1 year >= 1 year Any Time

Death with functioning Graft

Cardiac 19 (27%) 178 (22%) 197 (22%) 5 (50%) 44 (29%) 49 (30%)

Vascular 7 (10%) 69 (8%) 76 (9%) 1 (10%) 8 (5%) 9 (6%)

Infection 29 (41%) 133 (16%) 162 (18%) - 23 (15%) 23 (14%)

Social 2 (3%) 66 (8%) 68 (8%) 1 (10%) 8 (5%) 9 (6%)

Malignancy 5 (7%) 276 (34%) 281 (32%) 2 (20%) 53 (35%) 55 (34%)

Miscellaneous 8 (11%) 93 (11%) 101 (11%) 1 (10%) 15 (10%) 16 (10%)

Total 70 (100%) 815 (100%) 885 (100%) 10 (100%) 151 (100%) 161 (100%)

Graft Failure

Rejection - Acute 30 (21%) 25 (2%) 55 (5%) - 6 (4%) 6 (4%)

Rejection - Chronic Allograft (CAN) 10 (7%) 795 (79%) 805 (70%) 1 (7%) 105 (71%) 106 (65%)

Rejection - Hyperacute 3 (2%) - 3 (<1%) - - -

Vascular 44 (31%) 14 (1%) 58 (5%) 5 (33%) 4 (3%) 9 (6%)

Technical Problems 12 (9%) 5 (<1%) 17 (1%) - - -

Glomerulonephritis 8 (6%) 63 (6%) 71 (6%) - - -

Non Compliance 1 (1%) 38 (4%) 39 (3%) 1 (7%) 9 (6%) 10 (6%)

Other 33 (23%) 67 (7%) 100 (9%) 5 (33%) 9 (6%) 14 (9%)

Cause of Loss

Total 141 (100%) 1007 (100%) 1148 (100%) 15 (100%) 148 (100%) 163 (100%)


8-14

IMMUNOSUPPRESSION

AUSTRALIA

Immunosuppression data for 2012 was reported poorly in both Australia and New Zealand. At the time of data lock for analysis, over half of patients transplanted in 2012 were transplanted in hospitals where the proportion of patients reported to be receiving no baseline immunosuppression was unrealistically low. For this reason we are not reporting immunosuppression data at this stage.

ANZDATA is following up with contributing units and hopes to release an online-only supplement to this year’s Report once data capture is considered complete. We are also planning to revise our data collection form to improve completeness of reporting.

Aza = Azathioprine CyA = Cyclosporine Tacrol = Tacrolimus MMF = Mycophenolate Mofetil MPA = Mycophenolic Acid (Enteric Coated) Sirol = Sirolimus Pred = Prednisolone


Immunosuppressive Therapy - Primary Deceased Donor Graft 2005 - 2012

Year Aza CyA Tacrol MMF Sirol Everolimus Pred Number of Deceased

Donor Grafts

Initial treatment

2005 9 (3%) 131 (41%) 172 (54%) 299 (94%) 17 (5%) - 308 (97%) 319

2006 - 155 (51%) 139 (45%) 260 (85%) 3 (1%) 19 (6%) 296 (97%) 306

2007 2 (1%) 138 (48%) 140 (49%) 244 (85%) - 5 (2%) 285 (99%) 287

2008 2 (1%) 137 (35%) 240 (61%) 364 (93%) - - 389 (99%) 391

2009 4 (1%) 62 (16%) 310 (82%) 356 (95%) - 3 (1%) 375 (100%) 376

2010 - 66 (14%) 409 (86%) 426 (89%) 1 (<1%) 3 (1%) 477 (100%) 478

2011 1 (<1%) 54 (11%) 446 (87%) 300 (59%) - - 505 (99%) 511

2012

Treatment at

12 months

2005 23 (8%) 83 (29%) 172 (59%) 229 (79%) 29 (10%) 3 (1%) 262 (90%) 291

2006 12 (4%) 94 (34%) 145 (52%) 216 (78%) 21 (8%) 20 (7%) 259 (93%) 278

2007 13 (5%) 86 (32%) 149 (56%) 189 (71%) 12 (5%) 14 (5%) 252 (95%) 265

2008 17 (5%) 84 (23%) 251 (70%) 288 (80%) 12 (3%) 9 (2%) 345 (96%) 361

2009 18 (5%) 40 (11%) 283 (80%) 282 (80%) 18 (5%) 9 (3%) 341 (96%) 354

2010 24 (5%) 52 (11%) 370 (81%) 323 (71%) 16 (4%) 11 (2%) 440 (97%) 454

2011

Treatment at

24 months

2005 23 (8%) 76 (27%) 156 (55%) 220 (78%) 45 (16%) 5 (2%) 238 (84%) 282

2006 15 (6%) 81 (30%) 144 (53%) 207 (76%) 23 (8%) 25 (9%) 248 (92%) 271

2007 12 (5%) 79 (31%) 152 (59%) 181 (70%) 14 (5%) 13 (5%) 243 (94%) 259

2008 20 (6%) 80 (23%) 238 (68%) 275 (79%) 12 (3%) 9 (3%) 324 (93%) 350

2009 23 (7%) 39 (11%) 273 (79%) 254 (74%) 20 (6%) 11 (3%) 328 (95%) 344

2010

MPA

4 (1%)

24 (8%)

36 (13%)

22 (6%)

13 (3%)

37 (8%)

204 (40%)

21 (7%)

27 (10%)

51 (19%)

37 (10%)

39 (11%)

82 (18%)

23 (8%)

31 (11%)

54 (21%)

39 (11%)

53 (15%)

8-15


IMMUNOSUPPRESSION

NEW ZEALAND

See note on page 8-14

Aza = Azathioprine CyA = Cyclosporine Tacrol = Tacrolimus MMF = Mycophenolate Mofetil MPA = Mycophenolic Acid (Enteric Coated) Sirol = Sirolimus Pred = Prednisolone


Immunosuppressive Therapy - Primary Deceased Donor Graft 2005 - 2012

Year Aza CyA Tacrol MMF Sirol Everolimus Pred Number of Deceased

Donor Grafts

Initial treatment

2005 - 32 (76%) 8 (19%) 41 (98%) - - 41 (98%) 42

2006 - 26 (68%) 11 (30%) 34 (92%) - 3 (8%) 37 (100%) 37

2007 - 43 (74%) 15 (26%) 57 (98%) - 1 (2%) 58 (100%) 58

2008 - 30 (67%) 15 (33%) 42 (93%) - - 45 (100%) 45

2009 - 39 (78%) 10 (20%) 49 (98%) - - 49 (98%) 50

2010 - 32 (71%) 13 (29%) 45 (100%) - - 45 (100%) 45

2011 - 41 (71%) 17 (29%) 58 (100%) - - 58 (100%) 58

2012

Treatment at

12 months

2005 2 (5%) 21 (55%) 16 (42%) 33 (87%) 2 (5%) 1 (3%) 35 (92%) 38

2006 - 18 (53%) 15 (45%) 29 (88%) - 3 (9%) 32 (97%) 33

2007 3 (6%) 31 (60%) 20 (38%) 43 (83%) 2 (4%) 1 (2%) 48 (92%) 52

2008 2 (5%) 21 (48%) 23 (52%) 39 (89%) - - 41 (93%) 44

2009 - 24 (50%) 23 (48%) 48 (100%) 1 (2%) - 45 (94%) 48

2010 2 (5%) 16 (37%) 27 (63%) 41 (95%) - - 42 (98%) 43

2011

Treatment at

24 months

2005 2 (6%) 18 (50%) 17 (47%) 30 (83%) 2 (6%) 1 (3%) 29 (81%) 36

2006 - 16 (50%) 16 (50%) 28 (88%) - 2 (6%) 30 (94%) 32

2007 3 (6%) 29 (58%) 20 (40%) 41 (82%) 2 (4%) 1 (2%) 45 (90%) 50

2008 2 (5%) 20 (48%) 22 (52%) 37 (88%) 1 (2%) - 40 (95%) 42

2009 - 21 (46%) 24 (52%) 45 (98%) 1 (2%) - 42 (91%) 46

2010

MPA

-

-

-

3 (7%)

-

-

-

1 (3%)

-

-

1 (2%)

-

-

1 (3%)

-

-

-

-


8-16

Figure 8.36

Antibody Use for Induction Immunosuppression Australia and New Zealand 2008 - 2012

Number of Kidney Transplant Recipients Receiving Each Agent by Year

(% Total New Transplants)

2008 2009 2010 2011 2012

Australia

Muromonab-CD3 - 1 (0.1%) - -

Intravenous immunoglobulin 25 (3.1%) 28 (3.6%) 39 (4.6%) 42 (5.1%)

Anti-CD25 740 (91.0%) 715 (92.5%) 800 (94.6%) 765 (92.7%)

Rituximab 21 (2.6%) 17 (2.2%) 9 (1.1%) 10 (1.2%)

T cell depleting polyclonal Ab 22 (2.7%) 40 (5.2%) 52 (6.1%) 33 (4.0%)

Total new transplants 813 773 846 825 845

New Zealand

Intravenous immunoglobulin - - - -

Anti-CD25 74 (60.7%) 63 (52.1%) 65 (59.1%) 114 (96.6%)

Rituximab 1 (0.8%) 2 (1.7%) 1 (0.9%) 3 (2.5%)

T cell depleting polyclonal Ab - - 1 (0.9%) 1 (0.8%)


USE OF ANTIBODY THERAPY FOR INDUCTION IMMUNOSUPPRESSION

AUSTRALIA AND NEW ZEALAND

As with the immunosuppression data, the induction antibody data reported to ANZDATA for the 2012 survey were incomplete (see note on page 8-14). For this reason we are not reporting 2012 induction antibody use at this time. Once again, we hope to release a supplemental report online once data capture is considered complete.

8-17


USE OF ANTIBODY THERAPY FOR TREATMENT OF REJECTION


Figure 8.37 shows the number of people who received antibody agents for treating acute rejection by calendar year. The number is also reported as a proportion of new transplant recipients in each calendar year, but readers should be aware that although the large majority of people experiencing acute rejection do so within the first six months of transplantation, some experience rejection after this time (when they would not necessarily be counted as a new transplant). For this reason the total number of transplant recipients treated during the year is also reported.

Muromonab-CD3 has been withdrawn from sale and was unavailable from 2011. The use of T cell depleting polyclonal Ab and Intravenous Immunoglobulin has decreased in 2012.

Figure 8.37

Antibody Use as Treatment for Acute Rejection Australia and New Zealand 2008 - 2012

Number of Kidney Transplant Recipients Receiving Each Agent by Year

(% Total New Transplants)

2008 2009 2010 2011 2012

Australia

Muromonab-CD3 10 (1.2%) 12 (1.6%) 2 (0.2%) - -

Intravenous immunoglobulin 89 (10.9%) 105 (13.6%) 92 (10.9%) 105 (12.7%) 41 (4.9%)

Anti-CD25 1 (0.1%) 1 (0.1%) - - -

Rituximab 24 (3.0%) 26 (3.4%) 15 (1.8%) 11 (1.3%) 6 (0.7%)

T cell depleting polyclonal Ab 19 (2.3%) 27 (3.5%) 41 (4.8%) 42 (5.1%) 20 (2.4%)


New Zealand

Muromonab-CD3 10 (8.2%) 8 (6.6%) 4 (3.6%) - -

Intravenous immunoglobulin 2 (1.6%) 7 (5.8%) 4 (3.6%) 3 (2.5%) 3 (2.8%)

Anti-CD25 1 (0.8%) - - 1 (0.8%) -

Rituximab - 3 (2.5%) - - 1 (0.9%)

T cell depleting polyclonal Ab 3 (2.5%) 2 (1.7%) 12 (10.9%) 11 (9.3%) 4 (3.7%)


Total transplants at risk 8064 8427 8893 9331 9723

Total transplants at risk 1422 1471 1514 1558 1591


8-18

REJECTION RATES


Figure 8.38 shows the proportion of patients experiencing rejection in the first six months after transplant. For both living and deceased donor primary grafts, the six month incidence of rejection has fallen over the last decade.

Rejection rates in subsequent grafts are more variable due to the lower number of recipients, but have not clearly fallen in either living or deceased donors.

Figure 8.38

Australia and New Zealand Rejection Rates at Six Months Post Transplant

Donor Source 2003 2004 2005 2006 2007 2008 2009 2010 2012

Living Donor

First graft 27.7% 21.6% 19.6% 19.6% 21.1% 17.0% 16.8% 17.8% 11.0%

Second and subsequent 33.3% 34.8% 18.5% 33.3% 34.3% 30.0% 24.3% 12.9% 10.3%

Deceased Donor

First graft 26.8% 22.8% 18.6% 16.3% 17.7% 22.0% 21.1% 18.7% 13.7%

Second and subsequent 25.0% 27.5% 31.7% 36.4% 32.8% 32.9% 36.5% 27.3% 19.2%

2011

17.5%

18.5%

20.0%

17.7%

8-19


SHORT TERM SURVIVAL - PRIMARY DECEASED DONOR GRAFTS

AUSTRALIA

Graft and patient survival for primary deceased donor grafts performed in Australia, calculated by the Kaplan-Meier method, is shown in Figure 8.39. The figures include graft losses or deaths on the day of transplant, and graft survival is not censored for death. Unadjusted one year patient and graft survival for primary deceased donor grafts in Australia have stabilised in the past ten years. Kaplan-Meier graphs illustrating this are shown in Figure 8.40.

Figure 8.39

Primary Deceased Donor - Australia Recipient and Graft Survival 1993 - 2012


Year of Transplant

Survival

1 month 6 months 1 year 5 years

Recipient Survival

1993-1994 (n=609) 99 (97, 99) 96 (94, 97) 95 (93, 97) 85 (82, 88)

1995-1996 (n=601) 99 (98, 100) 96 (94, 97) 95 (93, 97) 88 (85, 90)

1997-1998 (n=606) 99 (97, 99) 97 (95, 98) 96 (94, 97) 87 (84, 89)

1999-2000 (n=559) 99 (98, 100) 97 (96, 98) 96 (94, 97) 87 (84, 90)

2001-2002 (n=615) 99 (98, 100) 97 (96, 98) 96 (94, 97) 90 (88, 92)

2003-2004 (n=636) 99 (98, 100) 97 (95, 98) 96 (94, 97) 88 (85, 90)

2005-2006 (n=625) 99 (98, 100) 97 (96, 98) 96 (94, 97) 89 (86, 91)

2007-2008 (n=678) 99 (98, 100) 98 (97, 99) 97 (96, 98) 91 (89, 93)

2009-2010 (n=854) 99 (98, 100) 98 (97, 99) 98 (96, 98) -

2011-2012 (n=1044) 100 (99, 100) 98 (97, 99) 97 (96, 98) -

Graft Survival

1993-1994 (n=609) 93 (91, 95) 89 (86, 91) 88 (85, 90) 73 (69, 76)

1995-1996 (n=601) 95 (92, 96) 90 (88, 92) 89 (86, 91) 78 (74, 81)

1997-1998 (n=606) 95 (93, 97) 92 (90, 94) 90 (88, 92) 77 (74, 80)

1999-2000 (n=559) 96 (95, 98) 93 (91, 95) 92 (89, 94) 80 (76, 83)

2001-2002 (n=615) 96 (94, 97) 94 (92, 96) 92 (90, 94) 82 (79, 85)

2003-2004 (n=636) 94 (92, 96) 92 (90, 94) 91 (88, 93) 80 (76, 83)

2005-2006 (n=625) 95 (93, 97) 93 (91, 95) 91 (89, 93) 79 (76, 82)

2007-2008 (n=678) 96 (94, 97) 94 (92, 95) 92 (90, 94) 81 (78, 84)

2009-2010 (n=854) 98 (97, 99) 96 (95, 97) 95 (93, 96) -

2011-2012 (n=1044) 98 (97, 99) 96 (94, 97) 95 (93, 96) -

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Recipient survival - Australia

Primary Deceased Donor Grafts

Figure 8.40

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8-20

SHORT TERM SURVIVAL - PRIMARY DECEASED DONOR GRAFTS

NEW ZEALAND

Graft and patient survival for primary deceased donor grafts performed in New Zealand, calculated by the Kaplan-Meier method, is shown in Figure 8.41. Like Australia, the improvement in unadjusted one year patient and graft survival have stabilised in the past ten years, although there is greater random variation due to smaller overall numbers. Figure 8.42 presents these data as Kaplan-Meier curves.

Figure 8.41

Primary Deceased Donor - New Zealand Recipient and Graft Survival 1993 - 2012


Year of Transplant

Survival


Recipient Survival

1993-1994 (n=103) 96 (90, 99) 88 (80, 93) 85 (77, 91) 78 (68, 85)

1995-1996 (n=126) 98 (94, 100) 94 (89, 97) 93 (87, 96) 86 (78, 91)

1997-1998 (n=139) 99 (94, 100) 94 (88, 97) 94 (88, 97) 84 (77, 89)

1999-2000 (n=122) 97 (92, 99) 95 (89, 98) 93 (87, 97) 82 (74, 88)

2001-2002 (n=121) 99 (94, 100) 95 (89, 98) 95 (89, 98) 86 (78, 91)

2003-2004 (n=104) 99 (93, 100) 95 (89, 98) 95 (89, 98) 91 (84, 95)

2005-2006 (n=79) 99 (91, 100) 96 (89, 99) 96 (89, 99) 87 (78, 93)

2007-2008 (n=103) 99 (93, 100) 97 (91, 99) 96 (90, 99) 87 (79, 92)

2009-2010 (n=95) 100 99 (93, 100) 98 (92, 99) -

2011-2012 (n=108) 99 (94, 100) 99 (94, 100) 99 (94, 100) -

Graft Survival

1993-1994 (n=103) 83 (74, 89) 78 (68, 85) 74 (64, 81) 59 (49, 68)

1995-1996 (n=126) 91 (85, 95) 88 (81, 93) 84 (76, 89) 72 (64, 79)

1997-1998 (n=139) 93 (87, 96) 87 (80, 92) 86 (79, 90) 73 (65, 80)

1999-2000 (n=122) 89 (82, 94) 87 (79, 92) 84 (76, 89) 72 (63, 79)

2001-2002 (n=121) 95 (89, 98) 92 (85, 95) 92 (85, 95) 79 (71, 86)

2003-2004 (n=104) 93 (86, 97) 88 (81, 93) 88 (81, 93) 79 (70, 86)

2005-2006 (n=79) 92 (84, 97) 90 (81, 95) 90 (81, 95) 80 (69, 87)

2007-2008 (n=103) 97 (91, 99) 95 (89, 98) 93 (86, 97) 81 (72, 88)

2009-2010 (n=95) 99 (93, 100) 97 (91, 99) 96 (89, 98) -

2011-2012 (n=108) 95 (89, 98) 95 (89, 98) 95 (89, 98) -

Figure 8.42

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Recipient Survival - New Zealand


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8-21


Figure 8.43

Recipient and Graft Survival of Primary Grafts Deceased Donors - Australia and New Zealand

Recipient Survival Graft Survival

Time Period 1 year 5 yrs 10 yrs 15 yrs 20 yrs 1 year 5 yrs 10 yrs 15 yrs 20 yrs

1970-1974 (n=1149) 77.0% 57.4% 44.4% 34.2% 25.1% 58.2% 41.9% 30.3% 22.8% 14.6%

1975-1979 (n=1463) 81.0% 63.6% 49.4% 35.5% 26.2% 51.7% 36.0% 25.6% 17.7% 12.6%

1980-1984 (n=1595) 91.4% 75.1% 59.4% 45.9% 34.7% 63.3% 45.4% 32.1% 23.0% 16.2%

1985-1989 (n=1916) 92.1% 80.3% 64.5% 51.2% 39.6% 80.8% 65.8% 47.2% 32.9% 21.4%

1990-1994 (n=1906) 93.4% 83.9% 67.7% 53.2% 40.9% 85.0% 70.9% 50.7% 34.7% 23.7%

1995-1999 (n=1779) 94.7% 86.1% 72.4% 57.1% - 88.6% 76.2% 58.6% 41.7% -

2000-2004 (n=1850) 96.0% 89.1% 77.0% - - 91.6% 80.8% 64.0% - -

2005-2009 (n=1911) 96.7% 89.5% - - - 92.3% 80.5% - - -

2010-2014 (n=1675) 97.5% - - - - 94.9% - - - -

LONG TERM SURVIVAL - PRIMARY DECEASED DONOR GRAFTS AUSTRALIA AND NEW ZEALAND

The aim of this section is to summarise the longer term outcomes of kidney transplants in a survival metric rather than as rates - that is, to describe the proportion of grafts surviving at particular time points.

As can be seen from the tables and figures, the graft survival advantage of living over deceased donor recipients and first over subsequent grafts is consistent over time. The considerable jump in survival from the 1980-84 cohort to 1985-89 coincides with the introduction of Cyclosporin into routine clinical practice in Australia. Since that time there have been lesser but consistent improvements in graft survival.

Figure 8.44

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8-22

Patient and graft survival for second or subsequent deceased donor grafts in Australia, calculated by the Kaplan-Meier method, is shown in Figures 8.45 and 8.46.

Figure 8.45

Second and Subsequent Deceased Donor - Australia Recipient and Graft Survival 1993 - 2012


Year of Transplant

Survival


Recipient Survival

1993-1994 (n=121) 98 (94, 100) 98 (93, 99) 94 (88, 97) 86 (78, 91)

1995-1996 (n=107) 99 (94, 100) 97 (92, 99) 97 (92, 99) 86 (78, 91)

1997-1998 (n=109) 100 97 (92, 99) 95 (89, 98) 86 (78, 91)

1999-2000 (n=77) 99 (91, 100) 96 (88, 99) 95 (87, 98) 86 (76, 92)

2001-2002 (n=87) 99 (92, 100) 94 (87, 98) 92 (84, 96) 87 (78, 93)

2003-2004 (n=95) 99 (93, 100) 98 (92, 99) 95 (88, 98) 85 (76, 91)

2005-2006 (n=120) 100 99 (94, 100) 97 (91, 99) 88 (81, 93)

2007-2008 (n=125) 99 (94, 100) 98 (93, 99) 96 (91, 98) 85 (76, 90)

2009-2010 (n=142) 99 (95, 100) 97 (93, 99) 95 (90, 98) -

2011-2012 (n=133) 100 99 (94, 100) 99 (94, 100) -

Graft Survival

1993-1994 (n=121) 87 (79, 92) 85 (77, 90) 83 (76, 89) 70 (61, 78)

1995-1996 (n=107) 83 (75, 89) 78 (68, 84) 77 (67, 84) 61 (51, 69)

1997-1998 (n=109) 93 (86, 96) 89 (81, 94) 84 (76, 90) 73 (64, 81)

1999-2000 (n=77) 92 (83, 96) 88 (79, 94) 87 (77, 93) 68 (56, 77)

2001-2002 (n=87) 92 (84, 96) 85 (76, 91) 82 (72, 88) 67 (56, 75)

2003-2004 (n=95) 94 (86, 97) 94 (86, 97) 89 (81, 94) 72 (61, 80)

2005-2006 (n=120) 97 (91, 99) 93 (87, 97) 89 (82, 94) 71 (62, 78)

2007-2008 (n=125) 96 (91, 98) 93 (87, 96) 90 (84, 94) 70 (61, 78)

2009-2010 (n=142) 94 (89, 97) 93 (87, 96) 91 (85, 95) -

2011-2012 (n=133) 98 (94, 100) 98 (93, 99) 95 (89, 98) -

SHORT TERM SURVIVAL - SECOND AND SUBSEQUENT DECEASED DONOR GRAFTS


Figure 8.46

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Second and Subsequent Deceased Donor Grafts

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8-23


Figure 8.47

Recipient and Graft Survival of Second and Subsequent Grafts Deceased Donors

Australia and New Zealand

Graft Survival


1970-1974 (n=158) 79.1% 55.7% 42.4% 33.5% 26.6% 58.9% 37.3% 27.2% 21.5% 14.6%

1975-1979 (n=284) 78.2% 57.4% 44.7% 31.3% 20.0% 44.0% 28.2% 20.4% 15.0% 8.1%

1980-1984 (n=417) 90.6% 74.8% 59.0% 46.8% 37.1% 48.9% 36.0% 25.6% 20.3% 14.2%

1985-1989 (n=458) 93.7% 79.2% 62.8% 47.3% 35.1% 70.1% 51.7% 34.4% 23.2% 13.9%

1990-1994 (n=374) 93.0% 82.6% 67.9% 54.0% 40.8% 78.3% 64.2% 44.1% 31.2% 21.0%

1995-1999 (n=296) 95.9% 86.1% 73.3% 60.0% - 81.8% 66.6% 44.3% 31.1% -

2000-2004 (n=268) 93.7% 86.2% 74.8% - - 86.6% 70.1% 51.5% - -

2005-2009 (n=343) 96.2% 87.9% - - - 89.5% 73.1% - - -

2010-2014 (n=217) 96.3% - - - - 93.4% - - - -

Recipient Survival

LONG TERM SURVIVAL - SECOND AND SUBSEQUENT DECEASED DONOR GRAFTS


The long-term graft and patient survival of second and subsequent grafts is shown in Figures 8.47 and 8.48. There has been a steady improvement in both graft and patient survival, such that survival of subsequent grafts is now similar to primary grafts (Figures 8.43 and 8.44).

Figure 8.48

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8-24


Year of Transplant


Recipient Survival

1993-1994 (n=160) 100 99 (95, 100) 98 (94, 99) 94 (89, 97)

1995-1996 (n=186) 100 98 (95, 99) 97 (94, 99) 95 (90, 97)

1997-1998 (n=284) 100 99 (96, 99) 98 (96, 99) 96 (93, 98)

1999-2000 (n=320) 99 (98, 100) 98 (96, 99) 98 (96, 99) 94 (91, 96)

2001-2002 (n=410) 100 (98, 100) 99 (97, 100) 99 (97, 99) 95 (92, 97)

2003-2004 (n=419) 100 (98, 100) 99 (97, 100) 99 (97, 100) 94 (92, 96)

2005-2006 (n=463) 100 (98, 100) 100 (98, 100) 99 (98, 100) 97 (95, 98)

2007-2008 (n=557) 100 (99, 100) 99 (97, 99) 99 (97, 99) 94 (92, 96)

2009-2010 (n=564) 100 (99, 100) 99 (98, 100) 98 (97, 99) - 2011-2012 (n=447) 100 100 (98, 100) 100 (98, 100) -

Graft Survival

1993-1994 (n=35) 91 (76, 97) 89 (72, 96) 89 (72, 96) 74 (56, 86)

1995-1996 (n=46) 98 (86, 100) 98 (86, 100) 98 (86, 100) 76 (61, 86)

1997-1998 (n=57) 96 (87, 99) 96 (87, 99) 95 (85, 98) 72 (58, 82)

1999-2000 (n=66) 95 (87, 99) 94 (85, 98) 94 (85, 98) 82 (70, 89)

2001-2002 (n=83) 100 99 (92, 100) 99 (92, 100) 88 (79, 93)

2003-2004 (n=88) 97 (90, 99) 95 (88, 98) 95 (88, 98) 86 (77, 92)

2005-2006 (n=88) 99 (92, 100) 97 (90, 99) 95 (88, 98) 91 (83, 95)

2007-2008 (n=120) 98 (94, 100) 98 (92, 99) 97 (91, 99) 84 (76, 90)

2009-2010 (n=118) 99 (94, 100) 97 (92, 99) 97 (91, 99) -

2011-2012 (n=101) 97 (91, 99) 97 (91, 99) 95 (87, 98) -

Primary Living Donor Grafts 1993 - 2012 Recipient and Graft Survival



Year of Transplant

Primary Living Donor Grafts 1993 - 2012 Recipient and Graft Survival



Recipient Survival

1993-1994 (n=160) 100 99 (95, 100) 98 (94, 99) 94 (89, 97)

1995-1996 (n=186) 100 98 (95, 99) 97 (94, 99) 95 (90, 97)

1997-1998 (n=284) 100 99 (96, 99) 98 (96, 99) 96 (93, 98)

1999-2000 (n=320) 99 (98, 100) 98 (96, 99) 98 (96, 99) 94 (91, 96)

2001-2002 (n=410) 100 (98, 100) 99 (97, 100) 99 (97, 99) 95 (92, 97)

2003-2004 (n=419) 100 (98, 100) 99 (97, 100) 99 (97, 100) 94 (92, 96)

2005-2006 (n=463) 100 (98, 100) 100 (98, 100) 99 (98, 100) 97 (95, 98)

2007-2008 (n=557) 100 (99, 100) 99 (97, 99) 99 (97, 99) 94 (92, 96)

2009-2010 (n=564) 100 (99, 100) 99 (98, 100) 98 (97, 99) -

2011-2012 (n=447) 100 100 (98, 100) 100 (98, 100) -

Graft Survival

1993-1994 (n=160) 97 (93, 99) 96 (91, 98) 95 (90, 97) 85 (78, 90)

1995-1996 (n=186) 93 (88, 96) 91 (86, 94) 90 (84, 93) 84 (78, 89)

1997-1998 (n=284) 98 (96, 99) 97 (94, 98) 96 (94, 98) 87 (82, 90)

1999-2000 (n=320) 97 (94, 98) 95 (92, 97) 94 (91, 96) 86 (82, 90)

2001-2002 (n=410) 98 (96, 99) 96 (94, 98) 96 (93, 97) 88 (85, 91)

2003-2004 (n=419) 99 (97, 100) 98 (96, 99) 97 (95, 98) 88 (84, 91)

2005-2006 (n=463) 98 (97, 99) 98 (96, 99) 97 (95, 98) 90 (87, 93)

2007-2008 (n=557) 98 (96, 99) 97 (95, 98) 97 (95, 98) 88 (85, 91)

2009-2010 (n=564) 99 (98, 100) 98 (97, 99) 97 (95, 98) -

2011-2012 (n=447) 99 (97, 99) 98 (96, 99) 98 (96, 99) -

For primary living donor graft recipients, excellent patient and graft survival rates have been maintained despite the increased rates of living donor transplantation and corresponding increase in performing less ideal living donor transplants, particularly from older donors and unrelated donor transplants. Current patient and graft survival for primary living donor recipients in Australia and New Zealand are similar.

SHORT TERM SURVIVAL - PRIMARY LIVING DONOR GRAFTS AUSTRALIA AND NEW ZEALAND

8-25


Figure 8.51

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Recipient Survival - Australia

Primary Living Donor Grafts

Figure 8.52

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Figure 8.53

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Figure 8.54

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8-26

Figure 8.55

Recipient and Graft Survival of Primary Grafts Living Donors - Australia and New Zealand



1970‐1974 (n=21) 90.5% 81.0% 61.9% 52.4% 42.9% 85.7% 76.2% 61.5% 46.2% 20.5%

1975‐1979 (n=107) 90.7% 78.5% 71.0% 61.7% 52.2% 81.2% 63.3% 49.9% 41.2% 31.1%

1980‐1984 (n=241) 96.3% 85.4% 74.9% 64.8% 55.4% 82.8% 71.2% 59.3% 46.5% 35.9%

1985‐1989 (n=230) 95.2% 87.8% 79.9% 71.1% 62.9% 90.8% 74.8% 60.5% 45.1% 35.0%

1990‐1994 (n=431) 97.2% 89.2% 84.0% 74.5% 68.5% 91.8% 79.6% 65.3% 48.8% 32.0%

1995‐1999 (n=766) 98.6% 94.7% 86.6% 76.8% ‐ 94.5% 84.0% 68.8% 52.1% ‐

2000‐2004 (n=1193) 98.5% 94.3% 86.6% ‐ ‐ 95.9% 87.7% 72.4% ‐ ‐

2005‐2009 (n=1585) 98.5% 95.2% ‐ ‐ ‐ 96.7% 89.1% ‐ ‐ ‐

2010‐2014 (n=873) 99.0% ‐ ‐ ‐ ‐ 97.2% ‐ ‐ ‐ ‐

Figure 8.56

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LONG TERM SURVIVAL - PRIMARY LIVING DONOR GRAFTS AUSTRALIA AND NEW ZEALAND

8-27


Figure 8.57

Recipient and Graft Survival of Second and Subsequent Grafts Living Donors - Australia and New Zealand



1970-1974 (n=1) 100.0% 100.0% - - - 100.0% 100.0% - - -

1975-1979 (n=11) 100.0% 100.0% 81.8% 72.7% 63.6% 72.7% 45.5% 36.4% 36.4% 27.3%

1980-1984 (n=42) 97.6% 81.0% 78.6% 71.4% 51.9% 78.6% 64.3% 59.5% 50.0% 40.5%

1985-1989 (n=31) 96.8% 83.9% 71.0% 64.5% 47.5% 87.1% 74.2% 58.1% 45.2% 29.0%

1990-1994 (n=38) 100.0% 94.7% 73.3% 67.9% 51.3% 100.0% 86.8% 41.2% 35.7% 24.7%

1995-1999 (n=74) 98.6% 98.6% 89.2% 81.1% - 93.2% 82.4% 68.9% 57.9% -

2000-2004 (n=107) 98.1% 95.3% 85.7% - - 93.5% 85.0% 67.2% - -

2005-2009 (n=175) 98.3% 93.2% - - - 95.4% 82.1% - - -

2010-2014 (n=87) 98.7% - - - - 95.2% - - - -

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Figure 8.58

LONG TERM SURVIVAL - SECOND AND SUBSEQUENT LIVING DONOR GRAFTS



8-28


Philip Clayton

CHAPTER 9

KIDNEY DONATION


KIDNEY DONATION ANZDATA Registry 2013 Report _____________________________________________________________________________________

9-2

DECEASED KIDNEY DONORS

The data for this section come from the Australia and New Zealand Organ Donor (ANZOD) Registry. Much more information about deceased organ donors in Australia and New Zealand can be found on the ANZOD website, http://www.anzdata.org.au/anzod/v1/indexanzod.html. Figures 9.1 and 9.2 show the different types of deceased kidney donors in each country over 2003-2012. In Australia there has been a large increase in the number of donors since 2008, driven primarily by an increase in expanded criteria (ECD) and in particular cardiac death (DCD) donors. In New Zealand the donor numbers are steady and the proportion of ECD and DCD donors are much lower than in Australia.

The causes of death of deceased donors are shown in Figures 9.3 and 9.4. Stroke remains the most common cause of kidney donor death in both Australia and New Zealand. In Australia there has been a slight reduction in the proportion of deaths due to road trauma, with a corresponding increase in the proportion due to hypoxia/anoxia.

0

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Australia 2003-2012

Deceased Kidney Donor Type

DCDDBD ECDDBD SCD

Figure 9.1

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Deceased Kidney Donor Type

DCDDBD ECDDBD SCD

Figure 9.2

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StrokeHypoxia/anoxiaRoad trauma

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Cause of donor death

Figure 9.3

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Figure 9.4

ANZDATA Registry 2013 Report KIDNEY DONATION _____________________________________________________________________________________

9-3

Figures 9.7 and 9.8 show the discard rate of retrieved kidneys – the proportion of kidneys that were retrieved for the purpose of transplantation, but not ultimately transplanted into a recipient. The error bars represent 95% confidence intervals. Despite the increasing age and complexity of donors in Australia the discard rate has remained steady at around 3% over the last 10 years. In New Zealand discard rates have historically been slightly higher than in Australia (note the different y-axis scales), although over 2011-2012 the discard rate was <2%.

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Don

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Deceased kidney donor age

Figure 9.5

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Figure 9.6

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Discard rate of retrieved kidneys

Figure 9.7

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Figure 9.8

Figures 9.5 and 9.6 show the mean age of deceased kidney donors in Australia and New Zealand over the last 20 years. In Australia the mean age has increased steadily from 36 years in 1993 to 46 years in 2012. In New Zealand the trend is less clear, and donors are generally younger than in Australia; the mean donor age in 2012 was 44 years.


9-4

LIVING KIDNEY DONORS

AUSTRALIA There were 238 living donor kidney transplants performed in 2012 in Australia, representing 28% of all transplant operations (Figure 9.9). Living donor transplants have been falling as a proportion of all transplants since 2008 (Figure 9.10).

Figure 9.12 shows the number of living donors for the years 2003-2012 by donor age. Since 2008 the number of living donors decreased in the most common age groups of 35-44, 45-54 and 55-64.

The proportion of living donor transplants for each State and New Zealand for recipients aged 25-44 years is shown for the years 2005-2008 and 2009-2012 in Figure 9.11. Overall there has been a decrease in this age group for both countries from 2005-2008 to 2009-2012, more pronounced in Australia.

The proportion of genetically unrelated donors was 40% (96 donors) in 2012 compared with 50% (127 donors) in 2011, shown in Figures 9.13 and 9.16. Fifty-four percent of living unrelated donors were spouses or partners. The age distribution of living donors is shown in Figure 9.12.

There were five non-directed donors in 2012. ABO incompatible transplants in 2012 fell to 28 from a peak of 40 in 2010 (Figure 9.15).

NEW ZEALAND The number of living donor transplants decreased by 5% (54 donors) in New Zealand in 2012, as shown in Figure 9.14.

There were 32 genetically unrelated kidney donors in 2012, compared with 33 in 2011.

Fifty percent of grafts were from a living donor.

Unrelated donors represented 57% of all living donors in 2012, shown in Figures 9.14 and 9.16. More friends donated than spouses or partners.

There were four non-directed donors in 2012, similar to previous years.

Figure 9.9

Living Donor Operations as a Proportion(%) of Annual Transplantation

Australia 2007 - 2012

Recipient Age Groups

Year of Transplantation

2007 2008 2009 2010 20101

00-04 years 89% 75% 55% 60% 50%

05-14 years 56% 59% 71% 60% 46%

15-24 years 65% 67% 73% 76% 58%

25-34 years 57% 53% 54% 44% 40%

35-44 years 38% 36% 41% 41% 35%

45-54 years 43% 41% 39% 26% 22%

55-64 years 35% 39% 37% 31% 28%

65-74 years 45% 44% 33% 18% 23%

75-84 years 0% 0% 0% 67% 50%

All Recipients 44% 44% 42% 35% 31%

2012

71%

68%

58%

29%

32%

21%

21%

25%

50%

28%

Figure 9.11

3328

4239

51

42 4440

4346 4339

5756

0

20

40

60

%

QLD

NSW/A

CT

Vic/Tas

SA/NT

WA

Aust

NZ

Age 25-44, 2005-2008 vs 2009-2012

Percentage Living Donor Grafts

2005-2008

2009-2012

Figure 9.10

7571

59

68 67

5853

2936

32

41

21

39

21

44

25

0

20

40

60

80

%

0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74

Age

Stratified by age, 2008 vs 2012

Percentage Living Donor Grafts - Australia

2008 (44%)2012 (28%)


9-5

218244 246

273 271

354327

296

255238

0

100

200

300

400

Num

ber

of tr

ansp

lant

s

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Australia 2003-2012

Source of Living Kidney Donor

Unrelated

Related

Figure 9.13

4448 46

49

58

69 6760

5754

0

20

40

60

80

Nu

mb

er

of

tra

nsp

lan

ts

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012


Source of Living Kidney Donor

Unrelated

Related

Figure 9.14

Figure 9.15

0

50

100

150

0

50

100

150

Num

ber

of tr

ansp

lant

s

2002 2004 2006 2008 2010 2012

Year of transplant

18-2425-34

35-4445-5455-6465-74

75+

Age of Living Donors in Australia 2003-2012

Figure 9.12

36

30

40

35

28

0

10

20

30

40

Nu

mb

er

of A

BO

i tra

nsp

lan

ts

2008 2009 2010 2011 2012

Australia 2008-2012

ABO Incompatible Living Donor Transplants


9-6

Figure 9.17 Gender of Living Kidney Donors 2008 - 2012

Source and State/Country of Transplant

2008 2009 2010 2011 2012 Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total

Related NSW/ACT 57% 43% 63 48% 52% 66 37% 63% 46 41% 59% 46 37% 57% 46 VIC/TAS 39% 61% 56 26% 74% 58 42% 58% 66 50% 50% 44 40% 60% 50

QLD 35% 65% 17 31% 69% 26 57% 43% 21 45% 55% 20 38% 62% 21 SA/NT 45% 55% 22 44% 56% 16 40% 60% 20 30% 70% 10 57% 43% 14 WA 41% 59% 17 55% 45% 20 42% 58% 24 50% 50% 8 55% 45% 11

Australia 46% 54% 175 39% 61% 186 42% 58% 177 45% 55% 128 42% 56% 142

New Zealand 47% 53% 38 49% 51% 41 57% 43% 37 50% 50% 24 48% 52% 23

Unrelated

NSW/ACT 31% 69% 51 37% 63% 41 41% 59% 37 43% 57% 42 41% 59% 27 VIC/TAS 52% 48% 60 35% 65% 40 41% 59% 39 43% 58% 40 47% 53% 36

QLD 33% 67% 27 41% 59% 29 36% 64% 22 25% 75% 16 30% 70% 10

SA/NT 37% 63% 19 86% 14% 7 38% 63% 8 50% 50% 6 33% 67% 9 WA 32% 68% 22 38% 63% 24 23% 77% 13 43% 57% 23 36% 64% 14

Australia 39% 61% 179 40% 60% 141 38% 62% 119 41% 59% 127 41% 59% 96

New Zealand 39% 61% 31 42% 58% 26 43% 57% 23 42% 58% 33 26% 74% 31

Figure 9.16

Source of Living Donor Kidneys 2008 - 2012 (x = identical twin) (+ = non identical twin)

Source Australia New Zealand 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

Total Living Donors 354 327 296 255 238 69 67 60 57 54

Related (175) (186) (177) (128) (142) (38) (41) (37) (24) (23)

Mother 46 53 48 38 40 6 5 3 0 4

Father 41 27 37 33 35 9 6 5 3 6

Sister 30 41 35 22 26 9 8 6 9 3

Brother 33 32 26 18 20 5 11 10 5 1

Identical twin sister 0 0 1 0 0 0 0 0 0 0

Identical twin brother 0 0 0 1 0 0 0 0 1 0

Non-identical twin sister 1 2 0 1 0 0 0 0 0 0

Non-identical twin brother 0 0 2 0 0 0 0 0 0 0

Daughter 6 4 4 5 3 1 4 2 2 4

Son 3 4 7 1 3 2 3 3 2 4

Grandmother 2 5 3 0 3 0 0 0 0 0

Grandfather 0 0 1 1 0 0 0 0 0 0

Cousin 5 5 4 2 4 2 0 3 1 0

Niece 0 1 1 1 0 1 2 1 0 1

Nephew 0 3 0 0 0 0 0 0 0 0

Aunt 7 6 7 3 4 1 2 2 0 0

Uncle 1 3 1 2 4 2 0 2 1 0

Unrelated (179) (141) (119) (127) (96) (31) (26) (23) (33) (31)

Wife 64 63 47 47 32 5 2 5 10 8

Husband 35 33 21 20 15 5 1 2 4 1

Mother-in-law 0 1 1 0 1 0 0 0 0 0

Father-in-law 1 0 1 0 1 0 0 0 0 0

Stepmother 1 0 0 0 0 0 0 0 0 0

Stepfather 2 0 0 0 1 1 0 1 0 0

Stepsister 1 0 0 0 0 0 1 0 0 0

Sister-in-law 4 4 0 2 1 1 0 0 0 0

Brother-in-law 1 3 1 0 2 1 0 1 1 0

Daughter-in-law 0 0 1 0 0 0 0 0 0 0

Son-in-law 1 1 0 0 0 0 1 0 1 0

Stepdaughter 1 0 0 0 0 0 0 0 0 0

Stepson 0 0 1 1 0 0 0 0 0 0

Partner 10 6 6 6 5 0 1 2 4 1

Friend 27 18 16 12 7 10 13 7 5 14

Non-directed 6 4 1 5 5 8 6 4 3 4

Pathological 13 6 11 9 12 0 0 0 0 0

Paired kidney exchange 5 2 8 25 11 0 0 0 2 2

Other 7 0 4 0 3 0 1 1 3 1


9-7

Figure 9.18

Timing of Living Donor Transplantation for Primary Grafts in Relation to Date of Dialysis Start

by Year of Transplant 2008 - 2012

2008 2009 2010 2011 2012

Aust

Pre-emptive 94 (30%) 108 (36%) 92 (35%) 87 (37%) 76 (36%)

<1 month post dialysis 5 (2%) 10 (3%) 6 (2%) 7 (3%) 6 (3%)

1 month to <1 year post dialysis 77 (24%) 81 (27%) 62 (23%) 66 (28%) 70 (33%)

>=1 year post dialysis 141 (44%) 99 (33%) 106 (40%) 73 (31%) 62 (29%)

NZ

Pre-emptive 20 (30%) 18 (31%) 15 (25%) 12 (23%) 15 (31%)

<1 month post dialysis 2 (3%) 1 (2%) 1 (2%) 1 (2%) 1 (2%)

1 month to <1 year post dialysis 14 (21%) 8 (14%) 10 (17%) 11 (21%) 12 (24%)

>=1 year post dialysis 30 (45%) 32 (54%) 33 (56%) 28 (54%) 21 (43%)

The timing of primary living donor transplants relative to the start of dialysis is shown in Figure 9.18.

The proportion of all primary living donor transplants performed “pre-emptively” in Australia was 36%, compared with 37% in 2012. There has been a gradual reduction in the number of pre-emptive transplants over the last few years (Figure 9.19). Twenty-nine percent of recipients had received dialysis treatment for twelve months or longer prior to a first living donor graft.

The proportion of pre-emptive primary living donor transplants in New Zealand was 31% in 2012 compared with 23% in 2011 (Figure 9.18). Forty-three percent received dialysis for twelve months or longer prior to being transplanted.

TIMING OF LIVING DONOR TRANSPLANTS

50 52

7265 62

94

108

9287

76

0

20

40

60

80

100

Num

ber

of tr

ansp

lant

s

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

2003-2012

Pre-emptive Transplants - Australia

Figure 9.19


9-8


Germaine Wong

Blair Grace

Philip Clayton

Jonathon C. Craig

CHAPTER 10

CANCER


10-2

CANCER REPORT ANZDATA Registry 2012 Report _____________________________________________________________________________________

There is now consistent evidence showing an increased risk of cancer by at least 1.5 and 2-fold for people on dialysis and with kidney transplants, respectively. Cancer is also second to cardiovascular disease as the major cause of mortality and morbidity in these patients. Cancer can occur de novo or recur after transplantation. Patients with a prior cancer are also at risk of developing a new cancer type after transplantation. In this report, we provide the overall and site-specific cancer risks for those on dialysis and with a functioning kidney allograft between 1965 – 2012. We will also present the incidence of disease recurrence and new cancer development among those with a prior cancer. Finally, several new and novel risk factors for cancer after transplantation have been established using data from the ANZDATA Registry. Understanding the potential modifiable risk factors of cancer may enable clinicians, health professionals and decision makers to develop strategies that may prevent and/or halt disease occurrence and progression in the future.

Figure 10.1 Cumulative incidence of all cancers (excluding non-melanocytic skin cancers) in Australia and New Zealand The cumulative incidence of cancers is similar between Australia and New Zealand. Over 9% of patients on renal replacement therapy (RRT) develop a cancer (excluding non-melanocytic) within 10 years of commencing RRT.

INTRODUCTION

0

5

10

15

Cum

ulat

ive

inci

denc

e (%

)

5778 1695 348New Zealand25716 7976 1697Australia

Number at risk

0 5 10

Years on RRT

AustraliaNZ

All Cancers, all patients

Figure 10.1

Figure 10.2

Cumulative (%) Incidence of all Cancers in Australia and New Zealand (excluding non-melanocytic skin cancers)

Country 6 months 1 years 2 years 5 years 10 years

Australia 1.3 (1.2, 1.5) 2.1 (2.0, 2.3) 3.5 (3.3, 3.7) 6.4 (6.1, 6.8) 9.4 (8.9, 9.9)

New Zealand 1.2 (1.0, 1.6) 1.9 (1.6, 2.3) 3.2 (2.8, 3.7) 6.0 (5.4, 6.7) 9.4 (8.4, 10.4)

CUMULATIVE INCIDENCE OF ALL CANCERS

10-3

ANZDATA Registry 2012 Report CANCER REPORT _____________________________________________________________________________________

Figures 10.3a and 10.3b Cumulative incidence of all cancers (excluding non-melanocytic skin cancer) among those with a functioning kidney transplant, stratified by age at transplant.

CUMULATIVE INCIDENCE OF ALL CANCERS AMONG THOSE WITH FUNCTIONING KIDNEY TRANSPLANTS

0

5

10

15

% D

evel

opin

g C

ance

r

0 5 10

Years with Graft

45+ years

0-44 years

All CancersFunctioning grafts - Australia

0

5

10

% D

eve

lopi

ng

Can

cer

0 5 10

Years on Dialysis

45+ years

0-44 years

All CancersDialysis patients - Australia

0

5

10

15

% D

eve

lopi

ng

Can

cer

0 5 10

Years with Graft

45+ years

0-44 years

All CancersFunctioning grafts - New Zealand

0

5

10

% D

eve

lopi

ng

Can

cer

0 5 10

Years on Dialysis

45+ years

0-44 years

All CancersDialysis patients - New Zealand

Figure 10.3a

Figure 10.3b

Figure 10.4a and 10.4b Cumulative incidence of all cancers (excluding non-melanocytic skin cancer) among those with a functioning kidney transplant, stratified by age at transplant.

Figure 10.4a Figure 10.4b

10-4


Figures 10.5 - 10.7 Cumulative incidence of the three most common cancer types among those on RRT in Australia and New Zealand. Cancer of the lung is the most common cancer type, followed by colorectal and urinary tract cancers.

CUMULATIVE INCIDENCE OF THE THREE MOST PREVALENT CANCER TYPES AMONG THOSE ON RRT IN AUSTRALIA AND NEW ZEALAND

0

0.5

1

1.5

% D

eve

lopi

ng

Can

cer

0 5 10

Years on RRT

Australia

New Zealand

Colorectal CancersAll patients

0

0.5

1

% D

eve

lopi

ng

Can

cer

0 5 10

Years on RRT

Australia

New Zealand

Kidney CancersAll patients

0

0.5

1

1.5

2

% D

eve

lopi

ng

Can

cer

0 5 10

Years on RRT

Australia

New Zealand

Lung CancersAll patients

Figure 10.5

Figure 10.6

Figure 10.7

10-5


FREQUENCY OF SITE-SPECIFIC CANCERS

Figure 10.8

Frequency of Site-Specific Cancers

Recipients who developed incident

cancer following first transplant

Recipients with prior cancer and developed a new cancer following

first transplant

Recipients with prior cancer and developed

cancer recurrence following first

transplant

All cancers (n, %) 2760 (100) 57 (100) 23 (100)

Colorectal 509 (18.4) 11 (19.3) 1 (4.4)

Urinary tract 370 (13.4) 8 (14.0) 7 (30.4)

Female genitourinary 288 (10.8) 1 (1.8) 3 (13.0)

Melanoma 295 (10.7) 8 (14.0) 3 (13.0)

Lung 218 (7.9) 8 (14.0) -

Haematological 217 (7.9) 4 (7.0) 2 (8.7)

Prostate 167 (6.1) 5 (8.8) -

Breast 150 (5.8) 6 (10.5) 6 (26.1)

Oral 126 (4.6) 3 (5.3) 1 (4.4)

Central nervous system (CNS)

93 (3.4) 2 (3.5) -

Thyroid/endocrine 67 (2.4) - -

Connective tissue 30 (1.1) 1 (1.8)

Others 54 (2.0) - -

Cancers with unknown site 165 (6.0) - -

Figure 10.8 Of the 21,415 transplanted patients, 651 (3.0%) had cancer prior to transplantation. A total of 23 patients experienced cancer recurrence during the follow-up. Fifty seven (out of 651, 8.7%) developed a new second cancer after transplantation. Among those with disease recurrence, cancers of the urinary tract system were most prevalent, followed by breast, lung cancers and melanomas.

10-6



Figure 10.9


Acute rejection and cancer risk Lim WH et al Transplantation 2014

Recipients who experienced acute rejection and treated with T-cell-depleting antibody were 40% more likely to develop incident cancer compared with those who did not experience acute rejection, particularly genitourinary tract cancers

Time on dialysis and cancer risk Wong G et al Transplantation 2013

There is a linear relationship between duration of dialysis and the risk of cancer after transplantation, with over 2.5-fold increase in the risk of lung and urinary tract cancers among recipients who had been on dialysis for the longest duration before transplantation

Immunosuppression pre-transplant and cancer risk Hibberd A et al Transplantation 2013

Use of pre-transplantation immunosuppression in the treatment of primary kidney disease is associated with 1.8-3.7-fold greater risk of anogenital cancers, non-Hodgkin's lymphomas, breast cancers and urinary tract cancers

Donor type and cancer risk Lim WH et al TSANZ abstract 2013

Compared to recipients of live-donor kidneys, recipients of expanded criteria deceased donor kidneys were at a 1.5-fold greater risk of developing incident cancers, particularly genitourinary cancers and post-transplant lymphoproliferative disease

Donor cancer transmission in kidney transplantation Systematic review of donor cancer transmission Xiao D et al Am J Transplant 2013

A total of 69 studies with 104 donor-transmitted cancer cases were identified, with the three most common transmitted cancer types being renal cell cancers (n = 20, 19%), melanoma (n = 18, 17%), lymphoma (n = 15, 14%) and lung cancers (n = 9, 9%). Recipients with donor-transmitted melanoma and lung cancers incurred the poorest overall survival and therefore donors with a history of melanoma or lung cancer should not be considered.

10-7



Sean Kennedy

Nancy Briggs

Hannah Dent

Stephen McDonald

Kylie Hurst

Philip Clayton

CHAPTER 11

PAEDIATRIC


11-2

PAEDIATRIC REPORT ANZDATA Registry 2013 Report _____________________________________________________________________________________

INCIDENCE AND PREVALENCE OF ESKD IN CHILDREN AND ADOLESCENTS 1991 - 2012

This year, as well as providing a summary of current trends in the frequency and causes of ESKD, the paediatric report will focus on dialysis delivery and adequacy, technique survival and biochemical out-comes, as well as an overview of the frequency, causes and treatment of children and adolescents with ESKD.

GENERAL OVERVIEW As shown in Figure 11.1, there is no clear long term trend in the incidence of children and adoles-cents developing ESKD and being treated with renal replacement therapy, although there are fluctu-ations from year to year. Prevalent numbers of treated ESKD have gradually increased across all age groups reflecting improved survival through increased duration of ESKD (Figure 11.2).

Figure 11.1

0

5

10

15

20

RR

T in

cide

nce

(per

mill

ion)

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

0-45-910-14

15-17

Age (years)

Incidence of RRT - Age 0-17 YearsAustralia

0

10

20

30

40

RR

T in

cide

nce

(per

mill

ion)

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

0-45-910-14

15-17

Age (years)

Incidence of RRT - Age 0-17 YearsNew Zealand

Figure 11.2

0

50

100

150

RR

T p

reva

len

ce (

pe

r m

illio

n)

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

0-45-910-14

15-17

Age (years)

Prevalence of RRT - Age 0-17 YearsAustralia

0

50

100

150

RR

T p

reva

lenc

e (p

er m

illio

n)

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

0-45-910-14

15-17

Age (years)

Prevalence of RRT - Age 0-17 YearsNew Zealand

11-3

ANZDATA Registry 2013 Report PAEDIATRIC REPORT _____________________________________________________________________________________

CAUSES OF ESKD IN CHILDREN AND ADOLESCENTS 2007 - 2012 Overall, glomerulonephritis remains the most common cause of ESKD in children and adolescents

(29%) but causes vary significantly with age. In young children renal hypoplasia/dysplasia is the most

common cause while reflux nephropathy is a common cause of ESKD in adolescents.

Figure 11.3

Causes of End Stage Kidney Disease In Children and Adolescents 2007 - 2012 Australia and New Zealand

Primary Renal Disease Age Groups (Years)

Total 0-4 5-9 10-14 15-17

GN 10 (12%) 20 (31%) 27 (33%) 40 (40%) 97 (29%)

Familial GN - - 2 (2%) 3 (3%) 5 (2%)


Polycystic Kidney Disease 8 (10%) 5 (8%) 1 (1%) 2 (2%) 16 (5%)

Medullary Cystic Disease - 1 (2%) 4 (5%) 2 (2%) 7 (2%)

Posterior Urethral Valve 7 (9%) - 11 (13%) 2 (2%) 20 (6%)

Haemolytic Uraemic Syndrome 7 (9%) 1 (2%) 2 (2%) 2 (2%) 12 (4%)

Hypoplasia/Dysplasia 24 (29%) 14 (22%) 10 (12%) 14 (14%) 62 (19%)

Cortical Necrosis 2 (2%) 2 (3%) 2 (2%) 3 (3%) 9 (3%)

Interstitial Nephritis - 1 (2%) 1 (1%) 1 (1%) 3 (1%)

Cystinosis - 1 (2%) 1 (1%) - 2 (1%)

Uncertain 1 (1%) 2 (3%) - 5 (5%) 8 (2%)

Misc/Other 19 (23%) 16 (25%) 16 (19%) 16 (16%) 67 (20%)

Total 82 65 83 100 330

Diabetes - - 1 (1%) - 1 (0%)

11-4


Figure 11.4

Modality of Initial Renal Replacement Therapy By Year of First Treatment - Australia and New Zealand

< 18 Years of Age at First Treatment

Current

Treatment

Year

2007 2008 2009 2010 2011 2012 Total

0-9 Years 20 23 27 22 29 26 147

HD 4 (3%) 6 (4%) 4 (3%) 5 (3%) 10 (7%) 8 (5%) 37 (25%)

PD 14 (10%) 15 (10%) 17 (12%) 14 (10%) 14 (10%) 12 (8%) 86 (59%)

Transplant 2 (1%) 2 (1%) 6 (4%) 3 (2%) 5 (3%) 6 (4%) 24 (16%)

10-17 Years 31 38 27 25 24 38 183

HD 12 (7%) 22 (12%) 12 (7%) 13 (7%) 8 (4%) 16 (9%) 83 (45%)

PD 12 (7%) 8 (4%) 12 (7%) 5 (3%) 10 (5%) 15 (8%) 62 (34%)

Transplant 7 (4%) 8 (4%) 3 (2%) 7 (4%) 6 (3%) 7 (4%) 38 (21%)

Total 51 61 54 47 53 64 330

MODALITY OF TREATMENT 2007 - 2012 The modality of the first renal replacement treatment is shown in Figure 11.4. Although numbers are

small and therefore fluctuate from year to year, around 20% of children and adolescents receive pre-

emptive kidney transplants. Of the remainder, similar numbers commence renal replacement therapy

with haemodialysis or peritoneal dialysis.

For prevalent patients (Figure 11.5), a very different pattern is seen, with the great majority of children and adolescents treated with a functioning transplant. This reflects the relatively high rate of transplan-tation among children.

Figure 11.5

Modality of Treatment for all Patients in Australia and New Zealand < 18 Years of Age at 31st December

Current

Treatment

Year

2007 2008 2009 2010 2011 2012 Total

Haemodialysis 24 (8%) 35 (11%) 29 (9%) 30 (9%) 29 (9%) 30 (8%) 177 (9%)

Peritoneal Dialysis 55 (18%) 54 (17%) 57 (18%) 50 (15%) 52 (16%) 49 (14%) 317 (16%)

Transplant 229 (74%) 225 (72%) 229 (73%) 245 (75%) 251 (76%) 275 (78%) 1454 (75%)

Total 308 314 315 325 332 354 1948

11-5


DIALYSIS DELIVERY AND ADEQUACY

Figure 11.6

2.5

3

3.5

4

Mea

n S

essi

ons/

Wee

k

2008 2009 2010 2011 2012

Australia

2.5

3

3.5

4

Mea

n S

essi

ons/

Wee

k

2008 2009 2010 2011 2012

New Zealand

Mean Sessions per Week (95% CI)Among Haemodialysis Patients

December 2008-2012

Figure 11.7

3.5

4

4.5

5

Mea

n H

ours

/Ses

sion

2008 2009 2010 2011 2012

Australia

3.5

4

4.5

5

Mea

n H

ours

/Ses

sion

2008 2009 2010 2011 2012

New Zealand

Mean Hours per Session (95% CI)Among Haemodialysis Patients

December 2008-2012

Figure 11.6 and 11.7 summarise the recent trends in HD practice among Paediatric patients.

DIALYSIS HOURS

11-6


HAEMOGLOBIN

Various dialysis process indicators are summarized in Figures 11.8 - 11.16. For all of these graphs, the box indicates the 25th, 50th, and 75th centiles. The “Whiskers” indicate the 95th centiles for each category.

50

75

100

125

150

175

200

Hb

(g

/L)

2008 2009 2010 2011 2012

Haemodialysis

50

75

100

125

150

175

200

Hb

(g

/L)

2008 2009 2010 2011 2012

Peritoneal Dialysis

Haemoglobin, December 2008-2012Australia

50

75

100

125

150

175

200

Hb

(g

/L)

2008 2009 2010 2011 2012

Haemodialysis

50

75

100

125

150

175

200

Hb

(g

/L)

2008 2009 2010 2011 2012

Peritoneal Dialysis

Haemoglobin, December 2008-2012New Zealand

Figure 11.8

40

60

80

100

2008 2009 2010 2011 2012 2008 2009 2010 2011 2012


HD PD

Per

cent

Use of Erythropoietic AgentsDecember 2008-2012

ERYTHROPOIETIC AGENT USAGE

FERRITIN

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

Fe

rriti

n (g

/L)

2008 2009 2010 2011 2012

Haemodialysis

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

Fe

rriti

n (g

/L)

2008 2009 2010 2011 2012

Peritoneal Dialysis

Ferritin, December 2008-2012Australia

0

500

1,000

1,500

2,000

Fe

rriti

n (g

/L)

2008 2009 2010 2011 2012

Haemodialysis

0

500

1,000

1,500

2,000

Fe

rriti

n (g

/L)

2008 2009 2010 2011 2012

Peritoneal Dialysis

Ferritin, December 2008-2012New Zealand

Figure 11.10

Figure 11.9

11-7


UREA REDUCTION RATIO (HD PATIENTS) KT/V (PD PATIENTS)

0

10

20

30

40

50

60

70

80

90

100

UR

R (

%)

2008 2009 2010 2011 2012

Australia

0

10

20

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60

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80

90

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UR

R (

%)

2008 2009 2010 2011 2012

New Zealand

URR 90% excluded as non-physiological.

Urea Reduction Ratio (HD Patients)December 2008-2012

0

1

2

3

4

5

Kt/V

2008 2009 2010 2011 2012

Australia

0

1

2

3

4

5

Kt/V

2008 2009 2010 2011 2012

New Zealand

Kt/V > 4 excluded as non-physiological.

Kt/V (PD Patients)December 2008-2012


Figure 11.14

Proportion of Prevalent Patients for whom URR or Kt/V was reported < 18 Years of Age at 31st December in Australia and New Zealand

2008 - 2012

Current Treatment

Year

Modality 2008 2009 2010 2011 2012

Australia Haemodialysis 56% 96% 96% 63% 61%

Australia Peritoneal Dialysis 13% 7% 10% 5% 10%

New Zealand Haemodialysis 80% 100% 100% 80% 86%

New Zealand Peritoneal Dialysis 94% 93% 90% 100% 80%

TRANSFERRITIN SATURATION

0

20

40

60

80

100

Tra

nsf

err

in S

atu

ratio

n (

%)

2008 2009 2010 2011 2012

Haemodialysis

0

20

40

60

80

100

Tra

nsf

err

in S

atu

ratio

n (

%)

2008 2009 2010 2011 2012

Peritoneal Dialysis

Transferrin Saturation, December 2008-2012Australia

0

20

40

60

80

100

Tra

nsf

err

in S

atu

ratio

n (

%)

2008 2009 2010 2011 2012

Haemodialysis

0

20

40

60

80

100

Tra

nsf

err

in S

atu

ratio

n (

%)

2008 2009 2010 2011 2012

Peritoneal Dialysis

Transferrin Saturation, December 2008-2012New Zealand

Figure 11.11

Dialysis adequacy is reported for the majority of NZ patients. However the reporting rates of adequacy for Australian patients are low, particularly for those on PD. The NZ data suggest that the majority of patients meet accepted targets for adequacy.

11-8


BIOCHEMICAL OUTCOMES

SERUM CALCIUM

SERUM PHOSPHATE

For HD patients, Serum Phosphate is reported from a pre-dialysis specimen of a mid–week session.

1

1.5

2

2.5

3

Ca

lciu

m (

mm

ol/L

)

2008 2009 2010 2011 2012

Haemodialysis

1

1.5

2

2.5

3

Ca

lciu

m (

mm

ol/L

)

2008 2009 2010 2011 2012

Peritoneal Dialysis

Serum Calcium, December 2008-2012Australia

1

1.5

2

2.5

3

Ca

lciu

m (

mm

ol/L

)

2008 2009 2010 2011 2012

Haemodialysis

1

1.5

2

2.5

3

Ca

lciu

m (

mm

ol/L

)

2008 2009 2010 2011 2012

Peritoneal Dialysis

Serum Calcium, December 2008-2012New Zealand

Figure 11.15

0

1

2

3

4

5

Ph

osp

ha

te (

mm

ol/L

)

2008 2009 2010 2011 2012

Haemodialysis

0

1

2

3

4

5

Ph

osp

ha

te (

mm

ol/L

)

2008 2009 2010 2011 2012

Peritoneal Dialysis

Serum Phosphate, December 2008-2012Australia

0

1

2

3

4

5

Ph

osp

ha

te (

mm

ol/L

)

2008 2009 2010 2011 2012

Haemodialysis

0

1

2

3

4

5

Ph

osp

ha

te (

mm

ol/L

)

2008 2009 2010 2011 2012

Peritoneal Dialysis

Serum Phosphate, December 2008-2012New Zealand

Figure 11.16

11-9


AT FIRST TREATMENT HAEMODIALYSIS ACCESS

VASCULAR ACCESS


Figure 11.17

0 0 0 017

100 100 100 10083

n=5 n=4 n=5 n=9 n=6

1330

18 13 9

8870

82 88 91

n=16 n=10 n=11 n=8 n=11

0

20

40

60

80

100

2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

0-9 years 10-17 years

AVF/AVG CVC

Per

cent

Vascular Access at First TreatmentAustralia 2008-2012

0 0

100 100

n=1 n=1

0 0 020

100 100 10080

n=6 n=2 n=2 n=5

0

20

40

60

80

100

2008 2009 2010 2011 2012 2008 2009 2010 2011 2012


AVF/AVG CVC

Per

cent

Vascular Access at First TreatmentNew Zealand 2008-2012

Figure 11.18

0

25

014

33

0

0

0

0

0

100

75

10086

33

0 0 0 0

33

n=5 n=4 n=2 n=7 n=6

40

70 6753

41

5

0 14

0

0

55

3019

4753

0 0 0 0 6

n=20 n=20 n=21 n=17 n=17

0

20

40

60

80

100

2008 2009 2010 2011 2012 2008 2009 2010 2011 2012


AVF AVG CVC Not reported

Per

cent

Prevalent Haemodialysis AccessAustralia 2008-2012

0 00 0

100 100

0 0

n=2 n=1

50

2033

80

57

13

0

0

0

0

38

8067

20

43

0 0 0 0 0

n=8 n=5 n=6 n=5 n=7

0

20

40

60

80

100

2008 2009 2010 2011 2012 2008 2009 2010 2011 2012


AVF AVG CVC Not reported

Per

cent

Prevalent Haemodialysis AccessNew Zealand 2008-2012

Vascular access for haemodialysis is summarised in Figures 11.17 -11.18.

11-10


HAEMODIALYSIS SURVIVAL BY AGE CATEGORY

0.00

0.25

0.50

0.75

1.00

75 23 11 10 4 3 110-17 years38 4 0 0 0 0 00-9 years

N at Risk

0 1 2 3 4 5 6

Years

0-9 years

10-17 years

Australia 2006-2012

HD Technique Survival by Age Category

Figure 11.19

0.00

0.25

0.50

0.75

1.00

22 9 7 3 3 2 110-17 years2 0 0 0 0 0 00-9 years

N at Risk

0 1 2 3 4 5 6

Years

0-9 years

10-17 years


HD Technique Survival by Age Category

Figure 11.20

Haemodialysis technique survival, censored for transplantation, loss to follow-up and recovery of renal function is presented above

Of the total 137 patients, 54 changed from HD to PD. Of those 54 patients, 30% changed within 30 days, 35% changed between 1 to 2 months and 31% changed between 2 and 6 months. 31% of patients received a transplant within 1 year and 34% received a transplant within 2 years.

11-11


PD technique survival, censored for transplantation, loss to follow-up and recovery of renal function is presented below. The numbers available for analysis after the first year drop significantly in each age group in both countries, due to transplantation. Of the 170 patients, 41 (24%) received a transplant within one year of commencement of RRT. By two years a total of 73 (43%) of patients had received transplants.

Use of PD solutions is shown in Figure 11.23.

PD TECHNIQUE SURVIVAL BY AGE CATEGORY

Figure 11.23

Use of PD Solutions 2009 - 2012

Solutions

Australia

2009 2010 2011 2012 2009 2010 2011 2012

(n = 43) (n = 40) (n = 40) (n = 39) (n = 14) (n = 10) (n = 12) (n = 10)

Glucose 42 (98%) 30 (75%) 28 (70%) 35 (90%) 14 (100%) 10 (100%) 12 (100%) 10 (100%)

Icodextrin 2 (5%) 2 (5%) 6 (15%) 9 (23%) 1 (7%) 0 (0%) 2 (17%) 3 (30%)

Low GDP Lactate 11 (26%) 17 (43%) 11 (28%) 5 (13%) 12 (86%) 8 (80%) 10 (83%) 5 (50%)

Low GDP Bicarbonate 1 (2%) 8 (20%) 6 (15%) 4 (10%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)

New Zealand

Figure 11.21

0.00

0.25

0.50

0.75

1.00

51 20 8 3 1 1 110-17 years74 38 11 2 1 0 00-9 years

N at Risk

0 1 2 3 4 5 6

Years

0-9 years

10-17 years

Australia 2006-2012

PD Technique Survival by Age Category

Figure 11.22

0.00

0.25

0.50

0.75

1.00

16 3 0 0 0 0 010-17 years23 15 2 1 0 0 00-9 years

N at Risk

0 1 2 3 4 5 6

Years

0-9 years

10-17 years


PD Technique Survival by Age Category

11-12


0.00

0.25

0.50

0.75

1.00

0 3 6 9 12 15 18 21 24 27 30 33 36

Months

0-6 (9)6-11 (9)

12-17 (12)

First PD Treatment to First Peritonitisby Age at First PD

Australia and New Zealand2008-2012

TIME TO FIRST PERITONITIS FOR PATIENTS < 18 YEARS OLD

Figure 11.24

0.84 0.85

1.07

0.61

0.99

0.76

1.01

1.23

0.50

60

30

18

15

12

10

8

Pat

ient

-Mon

ths

per

Epi

sode

.2

.4

.6

.8

1

1.2

1.4

1.6

Epi

sode

s pe

r P

atie

nt-Y

ear

2004 2005 2006 2007 2008 2009 2010 2011 2012

2004 - 2012

Episodes of Peritonitis per Patient-Yearand Patient-Months per Episode

Australia

Figure 11.25

Prior to 2012, there has not been an appreciable change in peritonitis rates in Australia, which have been around 1 episode of peritonitis per patient year. Time from commencement of PD to first peritonitis tends to be shorter in younger patients.

PERITONITIS RATES FOR PATIENTS < 18 YEARS OLD

ANZDATA Registry 2013 Report INDIGENOUS _____________________________________________________________________________________

12-1

Stephen McDonald

Matthew Jose

Kylie Hurst

CHAPTER 12 END-STAGE KIDNEY

DISEASE AMONG INDIGENOUS PEOPLES

OF AUSTRALIA AND NEW ZEALAND


INDIGENOUS ANZDATA Registry 2013 Report _____________________________________________________________________________________

12-2

Figure 12.1

New Patients 2007 - 2012 Australia New Zealand

Mode of Treatment

Non- Indigenous

ATSI Total Non-

Indige-nous

Maori Pacific People

Total

2007

PD 532 56 588 83 35 13 131

HD 1,546 183 1,729 139 108 64 311

Graft 65 0 65 23 3 0 26

2008

PD 606 51 657 96 35 22 153

HD 1,593 199 1,792 136 119 65 320

Graft 100 0 100 21 3 0 24

2009

PD 552 35 587 124 53 22 199

HD 1,558 159 1,717 158 121 81 360

Graft 115 2 117 22 2 0 24

2010

PD 460 36 496 88 47 28 163

HD 1,554 168 1,722 147 106 80 333

Graft 101 0 101 14 2 0 16

2011

PD 513 30 543 90 37 22 149

HD 1,591 220 1,811 152 89 72 313

Graft 99 0 99 15 0 0 15

2012

HD 1577 211 1788 138 120 73 331

Graft 89 0 89 16 1 1 18

Total 15,535 1,623 17,158 1,819 1,100 642 3,561

PD 614 43 657 100 46 18 164

INTRODUCTION

In this chapter, rates of end-stage kidney disease among Indigenous Peoples of Australia and New Zealand are presented. For Australia, these are Aboriginal and Torres Strait Islanders; for New Zealand, analyses include Maori and Pacific Peoples. In all cases, indigenous origin is reported by the renal unit on the basis of self-description. Maori and Pacific Peoples resident in Australia and Aboriginal and Torres Strait islanders resident in New Zealand are not considered “indigenous” unless otherwise specified. For some tables, we have also included data on Maori and Pacific Peoples living in Australia. While not indigenous to Australia, these have been included as useful comparators with the NZ experience of this group.

NEW PATIENTS

Australia

A total of 254 Aboriginal and Torres Strait Islander People commenced dialysis in Australia during 2012. The majority (88%) were treated with haemodialysis as their initial RRT modality. No pre-emptive transplants were performed among Aboriginal Australians in 2012.

New Zealand

The number of Maori and Pacific People starting dialysis increased in 2012 (166 patients) and decreased (91 patients) respectively.

46 (28% of total) Maori patients commenced on PD in 2012 while the number of Pacific Peoples starting with PD was 20%.

Figures 12.1 -

Figure 12.2

0

20

40

60

80

100

2008 2009 2010 2011 2012

Percentage of New Patients - AustraliaCommencing on Haemodialysis

ATSI Non Indigenous

Figure 12.3

0

20

40

60

80

100

2008 2009 2010 2011 2012

Percentage of New Patients - New ZealandCommencing on Haemodialysis

Maori Pacific People Non Indigenous

12.7


12-3

Overall, the incidence rates (per million population) of indigenous peoples in Australia and NZ are considerably higher than that for non-indigenous people. Direct comparisons are confounded by the different age distributions - the indigenous population for both countries is considerably younger than the non-indigenous population. Although rates fluctuate from year to year, in both countries the indigenous incidence rates have stabilised in recent years. The relative rate differs with age and also (for Aboriginal Australians) with gender - this is illustrated in Figure 12.5.

INCIDENCE RATES

Among Aboriginal Australians, there is a marked excess relative rate among those aged 35-64 years. The relative rate is higher among females than males.

Among Maori and Pacific People the excess rate is concentrated among older groups, and there is no gender difference.

Figure 12.5

0

5

10

15

20

Rel

ativ

e ra

te

0-14 15-24 25-34 35-44 45-54 55-64 65-74 75+Age (years)

Female Male

Australia, 2008-2012Relative incidence rate Aboriginal vs non Aboriginal

Figure 12.4

0

100

200

300

400

500

Pe

r m

illio

n p

er

yea

r

1985 1990 1995 2000 2005 2010Year

Aboriginal and TSI

Aboriginal & TSI, Australia

0

100

200

300

400

Pe

r m

illio

n p

er

yea

r

1985 1990 1995 2000 2005 2010Year

Maori Pacific Peoples

Maori and Pacific Peoples, treated in New Zealand

ANZDATANote X and Y scales differ

Unadjusted incident RRT rate

Figure 12.6

1

5

10

15

20

Re

lativ

e ra

te

0-14 15-24 25-34 35-44 45-54 55-64 65-74 75+Age (years)

Mäori Pacific Peoples

The relative rates for male and female are similar at all ages for Mäori and Pacific Peoples

New Zealand, 2008-2012

Relative incidence rateMäori & Pacific Peoples vs non-Mäori


12-4

The overall stabilisation of rates among Aboriginal Australians is seen consistently across each age group. In some age groups (such as 25-34 & 65-74 years) there is a suggestion of a downwards trend. There are a number of factors which contribute to incident numbers of RRT (among both indigenous and non-indigenous people). It is not clear whether this stabilisation reflects the underlying rates of diabetes, rates of disease progression, referral patterns or other diseases.

Figure 12.8

0

50

050

100150200

0

500

0500

10001500

5001000150020002500

01000200030004000

01000200030004000

0100020003000

19901995200020052010

19901995200020052010 19901995200020052010

0-14 15-24 25-34

35-44 45-54 55-64

65-74 75+

Rate 95% CI

Per

mill

ion

per

year

Year

note: Y axis scales differ

Aboriginal & TSI, AustraliaAge-specific incident RRT rate

There is also considerable variation between Australian jurisdictions in the Aboriginal/TSI RRT incident rates. The incidence rates for each State/Territory can be seen in Figure 12.7.

While rates for the very young (<15 years) and older (>65 years) groups are similar in each State/Territory, the rates for people 25-65 years of age show a clear trend of progressively higher rates from NSW/Victoria to Queensland then South Australia, Western Australia and the Northern Territory. Data is shown for a three year period given the small numbers in some locations.

020406080

100

pe

r m

illio

n p

er

yea

r

NS

W

Vic

Qld

SA

WA

NT

0-24 years

0

500

1000

1500

pe

r m

illio

n p

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yea

r

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W

Vic

Qld

SA

WA

NT

25-44 years

010002000300040005000

pe

r m

illio

n p

er

yea

r

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Vic

Qld

SA

WA

NT

45-54 years

100020003000400050006000

pe

r m

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n p

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yea

r

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W

Vic

Qld

SA

WA

NT

55-64 years

010002000300040005000

pe

r m

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n p

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yea

r

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W

Vic

Qld

SA

WA

NT

65-74 years

0

2000

4000

6000

8000

pe

r m

illio

n p

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yea

r

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W

Vic

Qld

SA

WA

NT

75+ years

ANZDATA and ABS data, 2010-12

among Aboriginal & TSI people, by state and age at RRT startAge-specific incidence rates of treated RRT

Rate 95% CI

Figure 12.7


12-5

Age specific trends for Maori and Pacific Peoples are shown in Figures 12.9 and 12.10. Note that the Y axis scale varies.

Figure 12.9

0

50

050

100150

0100200300

0100200300400

0500

10001500

5001000150020002500

0100020003000

0100020003000

19901995200020052010

19901995200020052010 19901995200020052010

0-14 15-24 25-34

35-44 45-54 55-64

65-74 75+

Rate 95% CI

Per

mill

ion

per

year

Year


Maori, New ZealandAge-specific incident RRT rate

020406080

0100200300

0100200300400

0200400600

0500

10001500

01000200030004000

01000200030004000

01000200030004000

19901995200020052010

19901995200020052010 19901995200020052010

0-14 15-24 25-34

35-44 45-54 55-64

65-74 75+

Rate 95% CI

Per

mill

ion

per

year

Year


Pacific Peoples, New ZealandAge-specific incident RRT rate

Figure 12.10


12-6

Figure 12.11

New Transplants 2001 - 2012


Year Donor Source

Non- Indigenous ATSI Maori Pacific

People Non-

Indigenous ATSI Maori Pacific People

2002 LD 226 0 1 3 43 3 2

DD 353 17 1 3 46 10 13

Total 579 17 2 6 89 13 15

2003 LD 214 3 0 1 33 8 3

DD 314 10 1 48 8 11

Total 528 13 1 1 81 16 14

2004 LD 239 4 0 1 39 5 4

DD 377 22 1 6 42 7 8

Total 616 26 1 7 81 12 12

2005 LD 239 3 0 4 44 2

DD 357 19 0 1 42 3 2

Total 596 22 0 5 86 3 4

2006 LD 265 3 0 5 42 4 3

DD 337 24 5 2 31 6 4

Total 602 27 5 7 73 10 7

2007 LD 261 4 1 5 45 9 4

DD 327 14 1 2 55 8 2

Total 588 18 2 7 100 17 6

2008 LD 341 7 2 4 58 7 4

DD 430 24 0 5 42 5 6

Total 771 31 2 9 100 12 10

2009 LD 320 4 2 1 58 8 1

DD 418 20 3 5 38 11 5

Total 738 24 5 6 96 19 6

2010 LD 292 0 1 3 49 7 4

DD 512 28 1 9 32 13 5

Total 804 28 2 12 81 20 9

2011 LD 249 2 1 3 49 6 2

DD 521 26 10 13 40 14 7

Total 770 28 11 16 89 20 9

2012 LD 235 0 3 0 49 4 1

DD 566 20 8 13 37 11 6

Total 801 20 11 13 86 15 7

In both Australia and New Zealand numbers of transplants to indigenous recipients were low.

Australia

Over the period 2002-2012 there was an increase in the number of transplants from deceased donors, which now have stabilised. Numbers from living donors remain extremely low. The table also contains transplants to Maori and Pacific people resident in Australia; the number of these increased over 2002-2010, and has now stabilised.

New Zealand

The number of transplants to Maori and Pacific Peoples recipients remains stable. In contrast to the situation in Australia, there is a higher proportion of transplants from living donors.

NEW TRANSPLANTS

Figure 12.12 Indigenous Transplant

Numbers. Australian figures include ATSI only.

0

10

20

30

0

10

20

30

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012


Deceased Live related Live unrelated

Nu

mb

er

Indigenous transplants numbersATSI in Australia, Maori and PP in New Zealand


12-7

Cumulative incidence curves (utilising competing risk techniques to account for the effects of both components of graft failure) are shown for indigenous transplant outcomes in Figure 12.13. It can be seen that for Aboriginal and TSI, there are higher rates of loss of graft function, and substantially higher rates of death with graft function compared with non-indigenous. Both of these differences are progressive over time. Lesser differences are seen for Maori / PP. In particular, the excess death rate among Maori/PP stabilises after the initial months.

Information on donor source is shown in Figure 12.14. There are substantially lower rates of living donation among indigenous groups in Australia, with a lesser difference in New Zealand. Australian figures include ATSI only.

Figure 12.14

0

.1

.2

0 1 2 3 4 5 0 1 2 3 4 5

Loss graft function Death with graft function

ATSI Aust non-indigNZ non-indig Maori/PP

Cu

mu

lativ

e in

cid

ence

Years

ANZDATA, all grafts 1 Jan 2001 to 31 Dec 2012DD1, cumulative incidence competing risks

Transplant outcomes

Figure 12.13

61%23%

16%

88%

5%7%

48%

31%

21%

65%

23%

12%

Australia Non-indigenous Australia Aboriginal/TSI

New Zealand Non-indigenous New Zealand Maori /Islander

Deceased Live related Live unrelated

ANZDATA, Donor source, grafts 1 Jan 2001 to 31 Dec 2012

Donor source, by indigenous status


12-8

Australia

The number of prevalent Aboriginal and Torres Strait Islander People with treated end-stage kidney disease increased to 1618, continuing a gradual increase. The percentage of ATSI on home haemodialysis was 7% in 2012 (this includes patients who perform independent self-care dialysis in community settings).

The percentage of ATSI treated with peritoneal dialysis was steady in 2012.

New Zealand

The number of prevalent Maori with treated end-stage kidney disease increased in 2012, whilst Pacific People remained the same. The percentage of Maori (24%) treated with home haemodialysis remains similar to past years, whilst in Pacific People this percentage (17%) has increased since 2008.

TREATMENT OF PREVALENT PATIENTS

Figure 12.15

Prevalent Patients 2008 - 2012 (% Haemodialysis Patients on Home HD)


Year Mode of Treatment

Non-Indigenous

Aboriginal/TSI Maori Pacific

People Non-

Indigenous Maori Pacific People

2008

PD 2015 166 21 40 434 224 108

HD 6711 (13%) 997 (5%) 58 (14%) 169 (14%) 550 (32%) 463 (24%) 329 (13%)

Func TX* 7430 159 29 62 1154 110 81

2009

PD 1997 142 18 46 453 238 109

HD 6981 (12%) 1042 (7%) 69 (16%) 177 (16%) 605 (33%) 492 (26%) 380 (13%)

Func TX* 7809 160 34 65 1196 117 84

2010

PD 1882 142 25 44 455 255 121

HD 7270 (12%) 1072 (7%) 78 (17%) 194 (15%) 628 (36%) 507 (26%) 421 (17%)

Func TX* 8232 177 33 73 1223 128 86

2011

PD 1868 134 22 48 428 247 120

HD 7498 (12%) 1173 (6%) 79 (18%) 211 (18%) 649 (36%) 500 (26%) 449 (16%)

Func TX* 8569 190 42 83 1252 141 88

2012

PD 1995 145 29 58 422 240 110

HD 7624 (12%) 1280 (7%) 83 (13%) 232 (16%) 674 (38%) 533 (24%) 490 (17%)

Func TX* 8978 193 49 90 1286 148 89

* By Resident Country at 31st December


12-9

The distribution of dialysis modality is shown graphically in Figures 12.16 below. Among indigenous Australians, the principal differences are a substantially lower rate of home HD and APD. This figure also includes the experience for Maori and Pacific Peoples treated in Australia at the end of 2012; their experience is similar to non-indigenous groups. Similar data is shown for New Zealand in Figure 12.17. Again, rates of home treatments (home HD in particular) are lower among the indigenous groups.

DIALYSIS MODALITY

Figure 12.16

13%8%

23%47%

9%5%

6%

19%

64%

6%

13%

13%

20%45%

10% 12%8%

21%46%

13%

Non-indigenous Aboriginal/TSI

Maori Pacific islander

APD CAPDHospital HD Satellite HD

Home HD

Patients at end 2012 dialysing and resident in Australia

Australia, by indigenous originDialysis modality end 2012

17%

21%

29%

9%

23% 18%

13%

34%

19%

17%

6%12%

43%

25%

14%

Non-indigenous Maori

Pacific islander

APD CAPDHospital HD Satellite HD

Home HD

Patients at end 2012 dialysing and resident in New Zealand

NZ, by indigenous originDialysis modality end 2012

Figure 12.17


12-10

In both Australia and New Zealand, there has been a gradual trend towards lower eGFR at the time of dialysis start, over 2011/12 among all groups. However, there is also a consistent difference (in both countries ) between indigenous and non-indigenous, with higher eGFR values among the non-indigenous groups.

ESTIMATED GLOMERULAR FILTRATION RATE AT TREATMENT START

02468

10

02468

10

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

Non - Indigenous Aboriginal/TSI


Med

ian

eGF

R (

mL/

min

/1.7

3m2

Excluding pre-emptive transplants

Australia

eGFR at Dialysis Start

Figure 12.18

02468

10

02468

10

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

1998

1999

2000

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2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

Non - Indigenous Maori

Pacific People

Med

ian

eGF

R (

mL/

min

/1.7

3m2

Excluding pre-emptive transplants

New Zealand

eGFR at Dialysis Start

Figure 12.19


12-11

INCIDENCE AND PREVALENCE BY STATE/TERRITORY

The next four pages show a variety of figures which summarise various key rates (incidence, prevalence, transplant rates) among indigenous people in Australia and New Zealand. In large part they show information from previous pages, in a series of differing formats.

State Incidence

The Northern Territory has the highest national incidence among indigenous people of treated end-stage kidney disease in Australia at 743pmp, the next highest is in South Australia (527 pmp).

Dialysis by Resident State

Treatment patterns for Aboriginal and Torres Strait Islander People vary by State. The highest rates are in the Northern Territory, Western Australia and South Australia.

Transplant by Referring State

Rates of prevalent transplants vary substantially between States with highest rates in South and Western Australia. These rates are per population, not per dialysis patient, and they reflect both background rates of kidney disease and transplant rates.

0

200

400

600

800

1,000

1,200

Per

mill

ion

AT

SI p

opul

atio

n

QLD NSW/ACT VIC/TAS SA NT WA Australia

Incidence of New ATSI Patients

Year

20082009

2010

2011

2012

Figure 12.23

0

50

100

150

200

Per

mill

ion

AT

SI p

opul

atio

n

QLD NSW/ACT VIC/TAS SA NT WA Australia

Incidence of New Transplants ATSI PatientsBy referring State

Year

2008

2009

20102011

2012

Figure 12.24


12-12

0

1,000

2,000

3,000

4,000

5,000

6,000

Per

mill

ion

AT

SI p

opul

atio

n

QLD NSW/ACTVIC/TAS SA NT WA Australia

Prevalence of HaemodialysisATSI Patients

Year

2008

2009

20102011

2012

Figure 12.25

0

100

200

300

400

500

600

700

Per

mill

ion

AT

SI p

opul

atio

nQLD NSW/ACTVIC/TAS SA NT WA Australia

Prevalence of Peritoneal DialysisATSI Patients

Year

2008

2009

20102011

2012

Figure 12.26

0

200

400

600

800

1,000

1,200

Per

mill

ion

AT

SI p

opul

atio

n


Functioning TransplantsATSI Patients

Year

2008

2009

20102011

2012

Figure 12.27

0

100

200

300

400

500

600

700

800

900

1,000

Per

mill

ion

AT

SI p

opul

atio

n


Deaths ATSI Patients

Year

2008

2009

2010

2011

2012

Figure 12.28


12-13

0

100

200

300

400

Per

Mill

ion

Pop

ulat

ion

2008 2009 2010 2011 2012

Incidence of New Patients - New ZealandMaori and Pacific People


Figure 12.29

0

10

20

30

40

Per

Mill

ion

Pop

ulat

ion

2008 2009 2010 2011 2012

Incidence of New Transplants - New ZealandMaori and Pacific People


Figure 12.30

0

250

500

750

1,000

1,250

1,500

Per

Mill

ion

Pop

ulat

ion

2008 2009 2010 2011 2012

Prevalence of Haemodialysis- New ZealandMaori and Pacific People


Figure 12.31


12-14

0

100

200

300

400

500

600

Per

Mill

ion

Pop

ulat

ion

2008 2009 2010 2011 2012

Prevalence of Peritoneal Dialysis- New ZealandMaori and Pacific People


Figure 12.32

0

100

200

300

400

Per

Mill

ion

Pop

ulat

ion

2008 2009 2010 2011 2012

Functioning Transplant - New ZealandMaori and Pacific People


Figure 12.33

0

100

200

300

Per

Mill

ion

Pop

ulat

ion

2008 2009 2010 2011 2012

Deaths - New ZealandMaori and Pacific People


Figure 12.34


12-15

GEOGRAPHICAL DISTRIBUTION

Figure 12.35 shows the number of incident ATSI (patients by postcode) The distribution of prevalent dialysis patients are summarized in Figure 12.36 (by state) and 12.37 by statistical subdivision (obtained by mapping postcodes to SSD). Note that some postcodes were distributed over more than one SSD

Incident numbers, by postcode, 2008-2013(50,100](20,50](10,20](5,10](2,5](1,2][0,1]

ANZDATA, indigenous patients only, based on postcode at first RRT

by postcodeIncident indigenous patients 2008-2012

Percent indigenous RRT patients, Dec 31 2012(75,100](50,75](20,50](10,20](5,10][0,5]No data

by state/territory

Prevalent indigenous patients, 31 Dec 2012


12-16

Figure 12.37

NSW Vic

Qld SA

WA NT

ANZDATA, based on postcode of residence reported at at end 2012mapped to SSD using ABS concordance files

31 Dec 2012Prevalent indigenous dialysis patients

Number of dialysis patients100 - 20050 - 10020 - 5010 - 205 - 102 - 51 - 20 - 1


12-17

Figure 12.39

Vascular Access Use at First ESKD Treatment Where this is Haemodialysis 2008 - 2012


Year Vascular Access

ATSI Maori Pacific People

Non-Indigenous


Non-Indigenous

2008 CVC 138 (58%) 9 (60%) 23 (64%) 1078 (58%) 100 (70%) 60 (85%) 128 (71%)

AVF/AVG 87 6 11 685 29 10 37

2009 CVC 110 (56%) 13 (52%) 25 (76%) 983 (54%) 99 (71%) 56 (64%) 138 (68%)

AVF/AVG 76 11 8 738 34 30 51

2010 CVC 113 (59%) 10 (56%) 23 (64%) 1003 (56%) 90 (74%) 65 (69%) 123 (66%)

AVF/AVG 69 7 10 692 24 20 44

CVC 135 (55%) 10 (45%) 26 (63%) 976 (52%) 68 (61%) 65 (74%) 135 (64%)

AVF/AVG 104 9 13 769 31 17 52

2012 CVC 125 (51%) 15 (79%) 33 (69%) 928 (51%) 88 (60%) 55 (61%) 99 (57%)

AVF/AVG 92 2 12 700 41 24 53

2011

VASCULAR ACCESS

For all indigenous groups in Australia and New Zealand the vascular access rates (at first HD) are stable over recent years. For both indigenous and non-indigenous groups these rates are higher in NZ than Australia.

Figure 12.38

Late Referral 2008 - 2012 % Late Referral of (Total Number of Patients)


Year ATSI Maori Pacific People

Non-Indigenous


Non-Indigenous

2008 24% (251) 24% (21) 32% (41) 21% (2238) 31% (157) 22% (87) 17% (253)

2009 22% (196) 32% (22) 37% (38) 20% (2175) 22% (177) 13% (103) 15% (304)

2010 25% (206) 19% (26) 26% (42) 22% (2056) 19% (155) 16% (109) 15% (251)

2011 30% (256) 19% (21) 17% (46) 22% (2173) 18% (129) 26% (95) 22% (261)

2012 25% (254) 34% (29) 26% (57) 21% (2194) 17% (167) 16% (92) 14% (254)

Australia

The percentage of Aboriginal and Torres Strait Islander People referred late for treatment has been stable for the last 3 years, and is very similar to the non-indigenous rate. In 2012 51% commenced haemodialysis using a catheter rather than permanent access (Figure 12.39); again this is a similar situation to the non-indigenous patients.

New Zealand

The proportion of Maori people referred late in 2012 decreased to 17% from 18% in 2011. For Pacific People referred late, the proportion decreased to 16% . Most Maori (60%) and Pacific People (61%) commenced haemodialysis with a catheter (Figure 12.39).

LATE REFERRAL


12-18

Figure 12.40

Incidence and Prevalence - Aboriginal And Torres Strait Islanders 2008- 2012 by Resident State (Number per million ATSI population in each state)

Australia

Year Mode of

Treatment QLD NSW/ACT VIC/TAS SA NT WA Australia

2008

New Patients 56 (367) 33 (202) 4 (75) 19 (651) 76 (1146) 63 (857) 251 (466) Prevalent HD 243 (1593) 108 (662) 31 (578) 62 (2124) 335 (5054) 218 (2965) 997 (1852) Prevalent PD 49 (321) 33 (202) 6 (112) 8 (274) 26 (392) 44 (598) 166 (308) Functioning 30 (197) 21 (129) 7 (130) 29 (994) 35 (528) 37 (503) 159 (295) Transplant 5 (33) 4 (25) 1 (19) 5 (171) 1 (15) 15 (204) 31 (58) Deaths 45 (295) 18 (110) 3 (56) 6 (206) 55 (830) 37 (503) 164 (305)

2009


2010

New Patients 62 (386) 30 (177) 13 (232) 17 (560) 52 (758) 32 (420) 206 (367) Prevalent HD 253 (1576) 120 (707) 42 (748) 67 (2205) 368 (5365) 222 (2913) 1072 (1909) Prevalent PD 49 (305) 29 (171) 5 (89) 2 (66) 29 (423) 28 (367) 142 (253) Functioning 30 (187) 26 (153) 10 (178) 33 (1086) 32 (466) 46 (604) 177 (315) Transplant 4 (25) 6 (35) 2 (36) 5 (165) 2 (29) 9 (118) 28 (50)

Deaths 55 (343) 18 (106) 1 (18) 9 (296) 42 (612) 38 (499) 163 (290)

2011



2012


12-19

Figure 12.41

Cause of Death 2012


Year Modality Cause Aboriginal/TSI Maori Pacific

People Non-

Indigenous Maori Pacific People

Non-Indigenous

2012

Dialysis Cardiac 53 (43%) 4 (44%) 13 379 (29%) 66 (53%) 33 (55%) 59 (34%)

Dialysis Vascular 7 (6%) 1 (11%) 1 (6%) 96 (7%) 9 (7%) 4 (7%) 10 (6%)

Dialysis Infec on 15 (12%) 1 (11%) 1 (6%) 102 (8%) 11 (9%) 6 (10%) 12 (7%)

Dialysis Social 35 (28%) 1 (11%) 1 (6%) 499 (39%) 17 (14%) 8 (13%) 54 (31%)

Dialysis Malignancy 2 (2%) ‐ ‐ 74 (6%) 6 (5%) ‐ 7 (4%)

Dialysis Miscellaneous 11 (9%) 2 (22%) 2 (11%) 142 (11%) 15 (12%) 9 (15%) 31 (18%)

Dialysis Total 123 9 18 1292 124 60 173

Transplant Cardiac 2 (33%) ‐ ‐ 33 (21%) 2 (50%) 1 (50%) 6 (29%)

Transplant Vascular ‐ ‐ ‐ 16 (10%) ‐ 1 (50%) 2 (10%)

Transplant Infec on 2 (33%) ‐ ‐ 22 (14%) 1 (25%) ‐ 2 (10%)

Transplant Social ‐ ‐ ‐ 16 (10%) ‐ ‐ 1 (5%)

Transplant Malignancy 2 (33%) 1 (100%) ‐ 45 (29%) 1 (25%) ‐ 8 (38%)

Transplant Miscellaneous ‐ ‐ 1 24 (15%) ‐ ‐ 2 (10%)

Transplant Total 6 1 1 156 4 2 21


12-20


anzdata 36th annual report

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